The Water-cure in Chronic Diseases: An Exposition of the Causes, Progress ...

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FOWLERS, WELLS &/ CO., j

Phrenologists & Publishers,

142 Washington St.^ Boston,

ion Phrenolojry, Physlolojrv Water Cure,
liiliv, INvcholotjv anil kindn*! snliloit*.
rfho lowest prices All tlic wo-ks In
f Ur Il<t Incliidincr llio IMirenolnvlcnl
pre Joiiri)Al«>. arc ««'nl bv Mnil.«»r
Mu'cnts from tMs oftiro nt t' o «anic
pTN.Y. rnif«'S8lonjil F.N ninhint Ions
I. ml vice as lo hrnltli. Hrir-improvo-

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Library

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PRESENTED BY

Section..
Shelf ..,
Number.

%^^'^^ '^

THB

WATER-CURE

nr

CHRONIC DISEASES;

gill Crpsilioii

Qf THX OACSKS, PB0QBB88, AND TBBMINATIOllB OF TAXIODB GHBOXXO 90-

KABS8 OF TBS DIOBSTHTB OBOANB, LtTNOB, KSBTXB, LDCBS, AND

8XIN ; AND OF THEIR TBBATMBNT BT WATER, AND OTHER

HTOISNIO MEANS.

ILLUSTRATED WITH AN ENGKAYED VIBW OP THE

^txbts of % f nnp, ftart, Sitamtli w^ ^bMl

BY

JAMES MANBY GULLY, M.D.,

necnxATi or tbx kotal colubgk or buboxohb akd rbllow or no botal i«iu(UJb

lOClXTT, XSIKBUSGa: RELLOW Or THS BOTAL IIXDICAL ASD OBIBUB9IOAL
BOOIimtS, LOXTDOK, XTC., XTa

** He told tb« hidden power of sprioga,
And Dlseaaa drank and slept"

SHBLLBT.—iVtffiMMMif Unbmmd^

NEW YORK:

rOWLERS AND WELLS, PUBLISHERS!^

CuNTON Hall, 131 Nassau Street.

Loitdon: 142 Strand.

Boston: | iftPi/t f Philadslphia:

No. 143 Washington St f 1004. { No. 281 Awh Strt«t

BOSTON MEDICAL LIBRARY

IN THE

FRANCIS A. COUNTWAY

UBRARY OF MEDICINE

Tbm white UnM in «ha opposite engnMvg tepnaont the ag|toiMvatlpiui aod Mt'Wacki
of nerroos matter, which eonstituto the cenffld portion of the system of nenres called thA
fangUonic, the nutritive, the organic, or the regetatiTe system. The ezteoeioB of Ihif
system is over the entire organs of the body. Wherever there is a blood-vessel to nomish
a part, fliere is ganglionic nervons matter teiegolate that nnttition. The twain itself is
Boniished under this influence : and in this manner the phenomena of the brain and spinal
oad and of the nerves proceeding thence, are regnlated by the ganglionic nervous matter
which pervades them. In the pagra of the following volume, the existence of chronle
disease in any part of the body is shown to be bound up with the existence of some phase
of disnrdMT in the central portions of the nutritive system of nerves here represented. The
physiologieal ftet of the prevalence of their ganglionic nervous matter over the whole
body is thus par^leled by the pathological fact of the prevalence of chronic disease la uy
part of the body, when the centre of it Lb disordered.

The upper number 1 points to the net-work of nutritive nerves which are.in the neigh*
bourhood of the oigans of respirafion and circulalion in the chest ; the lower number 1, to
those which supply the lower oigans of digestion, the colon, &c, Whilst at number S the
great central net-work is found whi<^ corresponds to the stomach and oth«r upper ocgcml
of digestion. The viscera themselves are here removed in order the better to show the
Mrves. But any representation ^ves but an imperfect idea pf the myriads of newes of
ibis system which prevail in the abdomen and chest geDerally.

PREFACE.

EvBBT writer supposes that his work is to supply soma
want. My object in publishing this treatise, is to afford a
truthful and rational exposition of the value of the water
treatment in certain chronic diseases. I apprehend that it is
wanted, because the works on the subject of the water cure
whicn have hitherto appeared in this country contain, so far
as my experience informs me, much overstatement as to its
operation, and are moreover written rather to catch the hope-
ful invalid, than to enlighten him as to the nature of his
disease, or the mode in which the water plan is to relieve it.
From this remark I except the work of Dr. E. Johnson,
entitled "Hydropathy," wherein the manner in which the
water cure operates t)n the chemistry of the living body is
very ably traced. The other works have not the slightest
claim to be called scientific.

In the First Fart of this work the origin, progress, exten-
sion, and terminations of Chronic Disease in general, are
delineated and explained, and one general deduction from
the facts made, namely, that no disease becomes chronie^
unless the central organs of nutrition are affected.

In the Second Fart, this is further developed in the his-
tory of individual chronic diseases, the explanation of the
pathology and symptoms of each of which is given, and also
of the reasons for the water treatment applicable to each. In
arranging the diseases, those are first treated of which affect

in PREFACE.

the primary organs of imtrition, the organs in which' the first
step in bloodmaking from food, and therefore of nutrition, is
taken. The next step of bloodmaking being eflfected by the
lungs and heart, their maladies are then treated of. The
circulation of the pOTfeeted blood being under the control of
the nervous system, the diseases of that system come the
next in order. One portion of the general nervous system,
namely, the brain and spinal cord and their nerves, having
control over the locomotive organs, the diseases of the limbs
CK»nQ %lm iie^t in order to be treated of. Finally, the blood
leaving been made and circulated, certain elements of it are
tlirown off in the shape of secretions from the bowels, kid*
neyis and skin : the diseases of which are the last to be men-*
tioned. The whole arrangement of these individua} maladies
is thus strictly physirfogical, beginning with the formation of
blood, and ending with the excretion of its useless portions.

Part Third treats, in the first place, of the mode in which
the water cure operates in producing its beneficial results, the
n^tionale being given under twelve sections. The subject is
treated generally, as that of Chronic Disease was in the First
Part, But, in the second place, the details of the water cure
are brought forward, the rationale of each process given, and
the circumstances which regulate their application stated.

Throughout the volume, the great pathological fact of the
existence of visceral disorder in all chronic disease is kept in
view ; and the attentive reader will find that, from beginning
to end, it fonns the basis of the practice recommended, and
of its explanation. And as the viscera play this important
part in the phenomem of chronic disease, it is not without
useful intent that an engraving of the ganglions and net^
works of nervous matter. which pervade them, arid regulate
their functions, is published at the commencement of the
Tolume.

The Apipenctiz c-ontains faets and aigamei^ iaBnsfmttk*

7EIFACS« ^

fMlW apcuMt^onft brought orally against the watei Imat*
meiA» chiefly by medical men^ although noue has ever yet
ventured to print them. This portion of the volume is a
i^iint from a former work of mine.

I put this work forward as an attempt in the right way oi
handling the subject of the water cure, with a hope that it
will be carried out by more able observers and writers.
Until it is treated gravely, earnestly, and trutJ^tiUy, as a
matter of scientific importance, it never will obtain the foot
ing i^ the opinion of the public which it ought to have : fc/
in this land of thinking heads, nothing endures unless it ad*
dresses itself to the sober thought. It is not by " Tributes **
and '' Confessions" of water patients that the water cure is
to be permanently advanced : they are mere puffs indirect,
which may answer a temporary purpose by luring the same
class of credulous people who would swallow pills or have
thfir iQorns cut on the strength of " Testimonials" in the
newspapers. But productions of that class do permanent in-
jury to the establishment of a new and philosophical mode
of treatment ; the thinking see through them, and disappoint-
ment awaits the imthinking, who expect to realize the glow-
ing pictures they exhibit : and thus a good cause is lost by
bad advocacy. Such advertisements, and those more direct,
which tell, in lengthened column, of water cure establish-
ments, are precisely what the enemies .of the treatment
would desire :

" Hoc Ithacus velit, magno mercentup Atridae."

Nor can the members of the medical profession be blamed
for refusing to acknowledge a plan of treatment so advocated.
Besides, they are probably aware that out of the number
now practising the water cure, not more than three have legi-
timate right to the title of " Doctor" which they append to
tbf i}:;ui^es All this is adverse to th^ advancement of th

Tifl FEBFACB.

water cure> which, opposed .as it is to old prejudices, requires
and has claim to all the aid which Truth and Science caa
afford.

To that Truth I have strongly adhered in the following
pages. What I have stated is altogether of my own e3cperi-
ence in an extensive field of practical observation during four
years : and be the result to lessen or exalt the reader's ideas
of the water cure, the Truth is told The cases recounted
were treated by me at Malvern. In publishing them I have
not descended to the vulgarity of publishing also the names
of the patients, nor can they be guessed at by initials or any
other token. The reader who requires such objectionable
evidence should apply it to himself and ask, " Who is safe
if medical attendants publish the names with the infirmities
of their patients?" Hence, such a proceeding is very pro-
perly rejected by the members of the medical profession as
undignified and indecent : and I apprehend that non profes*
.nional persons will not vitew it in any other hght.

J. M. GULLT.

CONTENTS.

PART I.

OF CHRONIC DISEASE IN GENERAL.

CsAVTsm I. Preliminary 1

«— n. Doctrine of Acute Disease *• • S

•— III. Doctrine of Chronic Disease * •• 11

«* IV. Phenomena of the extension of Chronic Disease . • • • 17
— y. The Causes, Progress, and Terminations of Chronie

Disease 32

PART II.

of particular chronic diseases and their
treatment/

CHAPm I. Diseases of the Primary Nutritiye Organs •• •• .. 65

Sect 1. Mucous and Nervous Indigestion • 68

— 2. Case of Nenrous Indigestion 80

Mucous Indigestion 02

Case of Mucous Indigestion • • • • 05

«. 3. Combination of Nenrous and Mucous Dyspepsia. ... 00
Case of Nervous and Mucous Dyspepsia.— Another Case

of Nenrous and Mucous Dyspepsia 102

— 4. (vastro-enteritis. — Chronic Inflammation of the Stom-

ach and small Bowel.— Atrophy • • .. • 100

Case of Atrophy or Wasting 113

5. Disorders of the Liyer and Duodenum 114

Case of Nenrous Disorder of the Liver 128

Case of Congested and Swollen Liver 120

Case of Obstructed Liver • 132

CKAVTxm n. Diseases of the Secondary Nutritive Organs. Diseases

of the Lungs and Heart 136

Sect 1. Nervous Cough.— Stomach Cough 137

Case of Stomach Cough 138

— . 3. Chronic Inflammation of the Air Tubes of the Lf ngs.—

Bronchitis 140

Case of Chronic Bronchitis •• • * .. •• 143

«» 8* Pulmonary Consumption • •• 146

t CDNTKNTf.

Case of threatening Consumptiye Disorder of the

Lungs. — Intense Stomach Irritation 147

Case of Pulmonary Consumption 190

Sect 4. Palpitation of the Heart— Organic Disease of the

Heart .. .. 151

Case ofNeryous Palpitation of the Heart 153

CHAPTsm III. Diseases of the Nervous System 157

Sect 1. Nenrousness. — Neuropathy.— Hypochondriasis •• •• 158
Case of minor degree of Nervousness . . . / . . . . 154
Another Case of minor degree of Nervousness . . . . 166
Case of Hypochondriasis, the greater degree of Nervous-
ness 169

— 2. Neuralgia. — ^NervePain. — ^Tic Douloureux.— Sciatica. —

Nervous Headache 171

Case of Sciatica 176

• Case of Neuralgia of both Legs 178

Case of Tic Douloureux of the Face 179

Another Case of Sciatica 182

^- 3. Apoplectic Fulness of the Brain. — Congestion of the

Brain.— -Palsy 187

Case of Apoplectic Fulness of the Head 196

Case of Apoplectic and Congestive Fulness of the Head.

— Deafness.— Intense Headache 198

Case of Palsy of the Right Leg 205

•^ 4, Spurious Palsy.— Chronic Congestion and Irritation of

all the Ganglionic Nerves 203

LiiAFTUi ly. Diseases of th& Limbs 217

Sect 1. Rheumatism .. « 218

Caseof Rheumatism of the Knee Joint 229

Case of general Rheumatism of the Body 233

Case of general Rheumatism with Nervous Signs. —

Neuralgic Rheumatism • •• •• 234

^ 2. Gout 236

Case of Nervous and Chalky Gout 245

— «. 3. Rheumatic Gout ., 248

CHAFTsm V: Diseases of the Lower Organs of Digestion — Diseases

of Excretory Organs .. .. 250

Sect 1. Diseases of the Colon. — Constipation 251

Cases of Constipation 266

•» 2. Hemorrhoids or Piles • 269

' Case of Internal or Blind Piles 272

— 3. Dropsy .- 275

Case of Dropsy of the Belly and Skin 382

^ 4 Skin Diseases • •• 384

Cases of 'Skin Diseases .. •• • 390

COXTBITTfl.

PART III.

PRINCIPLES AND DETAILS OF THE WATER TREATMENT OF
CHRONIC DISEASE.

CaAPTSR I. General Remarks on the Action of the Water Treatment 293

Chapter II. Details of the Water Cure • 327

Sect. 1. Hot and Warm Fomentations 328

— 2. Packing in Damp Towels and Sheets 332

— 3. The Sitz Bath .. 338

— 4. The Abdominal Compress • • • 340

— 5. The Dripping or Rubbing Sheet .. .. 344

— 6. The Shallow Bath 346

— 7. TheDouche ^. .. 340

— 8. The Sweating Process 353

— 9. Foot and Hand Baths and minor Ablutions and Frictions 358

— 10. Water Drinking 360

— 11. Air and Exercise 364

— 12. Diet 366

Diet Table for Patients under Water Treatment .. .^ 368

— 13. Clothing 371

' — 14 Habits of Life 374

Remarks on Water Cure Establishments 378

Appbhsiz. •• •• • .• 981

PART I.

OP CHRONIC DISEASE IN GENERAL.

CHAPTER I.

PRELIMINARY.

Nomenclature of chronic disease— Phases between that and acute diaeas*
— Acute disease always precedes chronic — Arrangement of the subjects
to be treated.

The epithet " chronic" is given by medical men to diseases whose
duration passes a certain limit of time ; and that limit has been
fixed at forty days. All within this period are generally de-
signated as. " acute ;" but as this would form but two extreme
classes of disease, whilst Nature exhibits several intermediate
phases, some writers have subdivided the " acute " diseases into
the most actUe, when they terminate in three or four days, — ^into
the very acute, when they do not continue longer than seven daySy
— into the simply acute, when they endure for fourteen da3r8,—
and into the sub-acule, when they reach forty days.

It will be plain, however, that these are merely arbitrary terms,
of which there are far too many in medicine, since they are apt
to be taken by the young or by the rautinier as guides in prac
tice ; and thus names, Instead of conditions of body, come to be
treated, and much mischief to be consequently perpetrated.
Now, the term " chronic" has in itself no reference whatever to
the actual state of the diseased frame ; and if I employ it in this
Essay, it is only that I may explain it, and fix some meaning t)
it as regards that state — ^the word being, in other respects, con-
nenient and precise enough.

Every disease is, in its onsetting, acute ; that is to say, the
2

S OF CHRONIC DISEASE IN 6BNBKAL.

symptoms are intense, ^pressing in character, and if Nature, either
with or without the aid of Art, does not soon bring relief, extin-
guishes the individual.

The relief and the escape from death are brought about either
by transfer of the morbid action irom the original seat of disorder
to some less important part, and the elimination of some secretions
therefrom, — an action to which the term crisis has for three thou-
sand years been applied ;* or, no such transfer occurring, the
acute state of disease in the affected part passes into the chronic
state, — chronic disease is established.

Preliminary, therefore, to fixing what constitutes chronic dis-
order, it is necessary that we should obtain some precise idea of
what constitutes the acute form. I shall next proceed to inquire
into the minute changes of organs which induce the phenomena
of chronic disease. AH the circumstances of chronic disease,
generally, will then be considered. Applications of the general
doctrine and ciroumstances will then be made to individual dis-
eases In the course of these inquiries, I shall take occasion to
show how acute disease is originated, and chronic disease main-
tained and exasperated, by internal stimulation; and finally, 1
shall show how the treatment of chronic disease by water, and
other hygienic means, obviates this inconvenience, is more safe
than any other plan of treatment, and comes in aid of the natural
and only permanent process towards recovery.

• It is well to note this^ as all the world has of late spoken of a " crisis"
as a new prodigy : a mistake which* some writers on the water-cure would
aeem to encourage, either from ignorance of the literature of medicine, or
from some silly idea that the novelty may add to the eclat of the treatment
they profess. HiPPociiATEs was the first to use the term crins at applied
to a terminar.on of disease, a id he lived a.m. 3500.

DOCTBIII£ OF ACVTB PISBASS,

CHAPTER II.

i

DOCTRINE OF ACUTE DISEASE.

What is meant by " general disease " and ** general debility " — Diseate
always begins in one organ-^The ganglionic system of nerves — Its centre
and extensive influence — Control over the blood-vessels^— Irritability
and se>sibiUty —Action of morbid causes on the irritability of the blood-
vesscil? — Theii contraction and exhaustion — Illustrations— Changes in the
movement and character of the blood — Periods in the process of acute
disease — Its extension — Shown in acute indigestion and simple inflam-
matory fever — Real cause of death from acute disease.

We are much in the habit of speaking of " general disease :" in
truth, there is no such thing. All the organs of the body may
give signs of diseased action, but there are invariably one or more
parts whose malady originates all that we see.

The brain may evidence disease by impaired volition, delirium,
sleeplessness, &c. ; the lungs, by rapid breathing, cough, &c. ;
the heart, by excessively quickened action ; the digestive organs,
by dry tongue, thirst, loss of appetite, nausea, constipation, &c. ;
the kidneys, by diminished secretion ; the skin, by unnatural
heat and dryness, — -yet all these multiform diseased actions may,
and very often do, depend on a sn\all patch of inflammation in the
stomach, perhaps no larger than a half-crown, or even a shilling.
To treat all these multiplied symptoms under the name of " gen-
eral disease," would be mere ignorance or sheer charlatanisniy
which ever aims at bustling complexity.

So also of *^ general debility," a term so common and so un-
meaning ; there is no such thing. Debility always signiifies the
disorder of one or more parts oppressing the healthy functions of
the rest of the body. Remove the disorder of those parts (it may
be by positively lowering remedies), and straightway the " general
debility" vanishes. Inflammation of any of the digestive organs
very shortly brings down the physical and mental vigor : which
as quickly rises when a few flannels wrung out of boiling water,
and applied over the abdomen, have removed the internal inflam«
mation. On this head I shall have more to say hereafter.

Disease, then, always commences in some one organ or set of

A DOCTRINE OF ACUTE DISSA&B.

organs, from which it spreads, with more or less rapidity, to
others, by a sympathy whose physical agent is the nervous sys-
tem .

By this term, " nervous system," the brain, spinal cord, and
the nerves proceeding from them, are ordinarily understood ; but
there is another system of nerves which, as it is neither obedient
to the will,- nor cognizant of pain, commonly so called, is rarely
considered in the explanation of disease ; in which it, neverthe-
less, plays by far the most important — I may say, the only im-
portant part. This system of nerves has been called the " gan-
glionic" (from the appearance of small knots or ganglions in the
course of the nerves), the "organic" (as regulating the character
of the organization of parts), the " nutritive" (as presiding over
the organs that minister to the nutrition of the body), and the
" visceral " (as pervading and having its centre in the viscera,*
that is, in the contents of the chest and abdomen) ; and I shall
use these terms indiscriminately in the course of this Essay.
Perhaps the most accurate, however, are the epithets " nutritive"
and " organic ;" for, wherever there are organs in the body, or
wherever nutrition goes on in it, there are nerves of nutrition to be
found. Wherever, too, there is a blood-vessel (and we know not
')f nutrition without blood), organic nerves accompany it and re-
gulate its action. In every part of the body, therefore, organic
nerves exist, as in every part of the body blood-vessels exist : the
point of the finest needle cannot be introduced into any tissue of
the frame without entering one or more blood-vessels and organic
nerves. f The brain itself, containing, as it does, so large a pro-
portion of the blood of the body, is, in this view, supplied also
with a large proportion of organic nerves.

The coincidence of nutritive blood-vessels (called also capillary)
and nutritive nerves points to some strict organic connection be-
tween them. In fact, it is the presence of the nerves which
imparts to the blood-vessels the property of receiving and reacting

* The word viscus, of which viscera is the plural, signifies, in the Latin,
slime. And as the older anatomists found the membranes which line the
lungs and digestive canal slimy from the mucus they secrete, they applied
the characteristic term to the parts themselves, calling each ore:an of the
chest and abdomen, viseus, and the general contents, viscera. This expla-
nation was necessary, from the frequency with which I shall be compelled
to use the term in these pages.

t Ruysch, William Hunter, and Lieberkuhn, asserted that every sub-
•tance of thf animal frame consisted of nothing but veaeels.

DOCTEINE 07 ACUTB DISBASE. 5

opOQ impressions from agents within or without the body— -a pro.
perty to which the name of " irritability" is given.

Let not the reader confound " irritability" with " sensibility,"
another property of a portion of the body. Irritability exists in th«
blood-vessels and organic nerves all over the frame — ^has its cen-
tral organs in the chest and abdomen — begets no sensation or
volition — is ever in action. Sensibility exists in the librves of the
brain and spinal cord only — ^has its central organs in the brain
and spinal cord — ^begets sensation and volition, and is suspended
in sleep. But, on the other hand, sensibility and sensation are
built upon irritability and irritation ; as thus — the brain is com-
posed of matter deposited from the blood-vessels, and these are
regulated in the manner and quality of their deposit by the amount
and character of their irritability ; therefore, if the irritability be
acted on vehemently (as in giving stimulants), the action of the
blood-vessels, otherwise called their irritation, is vehement also,
and they deposit more than usual of the brain matter which
possesses the property of sensibility, and in this way augmented
sensation is begotten. It is important to bear this in mind for the
future application to the doctrine of chronic disease — irritation
precedes sensation, sensation is built upon irritation.

The first effect, therefore, of causes of disease — excessive cold
or heat, infectious matter, &c. — ^is upon that nervous system which
presides over the capillary or nutritive blood-vessels, and whose
central portions are in the viscera of the chest and abdomen — ^the
ganglionic system.

It is ascertained by numerous experiments that the first effect
of all kinds of agents upon the nervously -endowed capillaries is to
produce contraction of them — a diminution of their calibre by the
fact of their oontractioh. In other words, all agents are stimulants
to them, and bring them into action, and that action is contraction.
But as all action is efS)rt, such effort must, in a living body, be
succeeded by lassitude and exhaustion ; and in the case of tb ese
small blood-vessels, relaxation and increase of calibre is the
evidence of this secondary state ; and further, it follows that the
amount of relaxation will be in exact proportion to the amount of
the previous contraction.

Of course the condition of the blood as to quantity is affected
by these' two opposite states of the vessels that contain it. When
the vesaels contract on the application of the morbid stimulus, they
drive tbeir contained blood from them; and ^ben relazatiOD

DOOTBIIfE OF ACUTE DISEASE.

ensuesy the blood rushes into their increased calibre ; and the
amount of blood thus brought into a part will be, of course, in '
exact proportion with the relaxation, and this with the contraction,
of the containing blood-vessels.

To illustrate all this: — ^I apply water at 35° of Fahrenheit to
the back of the hand when it is warm ; it first of all drives the
blood from tfle skin, and renders it pale ; this is because the cold
has stimulated the nutritive nerves of the blood-vessels, and caused
them to contract and drive the blood from them ; but in a very
short time the skin becomes more than usually red, and, if friction
be used, hot too. This is because the vessels have been exhausted
by the contracting effort, have relaxed, and admitted more blood
into them. This is an approach to inflammation of the skin of the
hand.

Or take a piece of frozen mercury, the temperature of which
is 38^ below the zero of Fahrenheit, and apply it on the hand.
The stimulus is so violent, the contraction .so excessive, as to be
uutantaneausly followed by excessive relaxation and total loss of
vital power of the blood-vessels, and inflammation of the most
destructive kind is produced. The part is burnt, in fact, as
efiectually as if the opposite stimulus of red-hot iron had been
applied.

Between these two instances the shades of stimulation and re-
laxation are inflnite, according to the morbific agent applied. The
more stimulating the agent, the more rapid and extreme the amount
of blood brought to the part, whether that part be the skin of the
hand, or the mucous lining of the stomach or lungs.

But whilst such are the conditions of morbid action in the blood-
vessels, what changes take place in 'the blood they contain ?

In the first* place, its movement through the blood-vessels of the
diseased part is retarded, in consequence of the diminished con-
tractile power of those vessels. There is more or less excess and
congestion of blood in the part, an excess which obtains at the ex-
pense of other and healthy parts. It is this excess which causes the
MweUkig of inflamed parts, their redness, their increased heat (the
unusual quantity of blood secreting an unusual quantity of caloric),
and their pamfulness, the pressure of the excessive blood on the
surrounding nerves rendering them irritable, although, as I shall
have occasion to show hereafter, inflammation of internal parts may
exist without pain (in the usual acceptation of the word) and with-
mUiednen.

BOOT&INE OF ACTTTK IHSBlSB. 7

in the next place, the chemical changes that go on in tho
blood undergo modification, in consequence oi his excess and
retardation of its movement. This is shown by the increased
heat already alluded to ; and further, if the inflammatory con-
gestion be not relieved, the blood secretes pus — ^the matter of
abscess— -either in the shape of a collection called an abscess, or
the same flows freely from the surface of a mucous membrane,
forming a bad kind of expectoration, &c. But the chemical
changes in question vary endlessly with the diseased part. In
the stomach, there is acid instead of insipid mucus and gastrio
juice ; in the liver, there is acrid and dark instead of slightly
bitter and yellow bile ; from the kidneys, acid instead of alkaline
secretion ; and so on. The most familiar instance of this as a
signal of disease is the state of the tongue when the mucous lining
of the stomach is disordered. The variety of the secretions there
is endless, and each one corresponds with a certain shade of con-
gestion of blood in the membrane that covers the tongue. Judge,
then, how numerous are the shades of diseased action in that
single tissue of the body !

Such, then, is the condition of a part when it is in the acute
stage of disease. The phases of the process may be briefly stated
as follows : —

1. The application of excessive stimulus to the nervously-
endowed blood-vessels of the part.

2. Excessive contraction of the blood-vessels in consequence*
with expulsion of their contained blood.

3. Exhaustion and relaxation of the same blood-vessels, with
consequent excessive influx and retention of blood in them.

4. Diseased sensation, secretion, and nutrition of the part, con-
sequent on the retention of the blood in the exhausted and relaxed
ressels, the vital chemistry being, for the time, improperly ear-
ned on.

These phases apply to all acutely diseased parts whatever—
from the small pimple on the skin to the most intense • inflamma-
:ion of the lungs or brain. In all, the same stages occur, what-
ever the exciting cause may be ; whether it be the atom of dirt
Irritating the follicle of the skin, and producing the pimple there,
or the rush of cold air into the lungs, irritating their mucous
membrane, and drawing excessive blood into it.

From what precedes, it appears that the intimate vital condition
of « part in acute disease is one of debility. The blood-vessels

9 SOCTAUfB OfAOUTM DISBAfiB.

haV9 kst their contractile energy, and are o|f>re88ed with Uood^
which they lack the power to throw off. But we must not, mean*
whiloy loee sight of the fact, that the organic nerves themselves,
whose re-action on excessive stimulus has produced all this mis-
chief, are also supplied with and nourished by blood-vessels;
and that therefore they, too, are in a state implying diseased sen-
sation and nutrition. In other words, they are exquisitely irrita-
ble, but their irritability is of a diseased quality, and not sustained,
because they are badly nourished by the biood ; the result of
which is a more than ordinary sensitiveness to the causes which
first induced the disease, or to aay stimulus whatever applied to
the part. Feeble contraction takes place, then more exhaustion ;
contraction again, and so on until all power is lost. Thus, a man
gets a slight inflammation of the mucous lining of the wind-pipe
from breathing very cold air ; allows the same cause to exasperate
it daily by acting on the highly irritable but feeble nerves aad
blood-vessels of the membrane ; and, finally, induces the most
intense form of inflammation of the lungs — a too frequent illus-
tration of the fact that the most fatal maladies commence in a
" slight cold.'*

Having thus established the fact, that acute disease of an organ
implies extreme debility, morbid irritability, and congestion of its
blood-vessels and organic nerves, we may now revert to the pro-
position, that all so-called general disease originates in some local
disorder — a proposition that will best be developed by tracing the
physical history of such a local condition as I have above de-
scribed. And we will take the local inflammation of an organ
whose sympathies are the most extensive — acute mucous inflam-
mation of the stomach, commonly called << acute indigestion."

A man incests highly seasoned meats and alcoholic drinks, and
begets in the mucous lining of his stomach a patch of such dis-
order I have minutely described. Now, though that disorder is,
as regards the patch itself, one of depressed vital power, it be-
comes to other parts a source of exalted vital action ; as if the
very fact of tbe existence of a diseased point roused the system
to efforts for its relief — an opinion that was held by Hiffoc]litbs»
and has prevailed with some of the soundest physicians since hi»
times.* The sympathy thus excited in other organs of the body

* Indeed, the doctrine that disease — t, e., a series of unnatural 83rmptom«
is constantly the signal of the whole body being excited to save some vital
pwt from destruction, obtains countenance from all the Acts thai 4lsse

HOGTRINt OF AOirrS DISEASB. 9

ifain piopoitkm to the amount and kind of nervous matter they
oontain. Thus, in the case before us, the ganglionic nervous
matter of the mucous membrane of the stomach excites the same
-matter distributed to the heart, whose beats are, in consequence,
increased in frequency and force ; the pulse becomes rapid and
hard ; as a result of this quickened pulse, the breathings alsa
quicken. Then comes the sympathy with the spinal cord and
•tiie brain, whose functions are rendered irregular or are op.
pressed ; hence the lassitude of mind and limb, the prostration
of strength, the somnolence first, and then the sleeplessness, &c.
Then there are the sympathies with the mucous surfaces of all
the other organs roused, causing the dimihution and vitiation of
their secretions ; hence the heaviness and the aching of the fore-
head, the suffused eyes, the fevered and dry tongue, the thirst,
the stoppage of the bile, the constipation of the bowels, the scan-
tiness of the secretion from the kidneys, all of them dependent
on mucous membranes. And as this mucous surface ex- .
tends to the outer part of the body, forming the true skin, the
same morbid sympathy extends thither, accompanied with the
same diminution and vitiation of sensation and secretion ; hence
the dry and hot skin called " feverish heat."

In fact, here is a case of what is called " simple inflammatory
fever," a general disease traceable to a small point of acute in-
flammation in the stomach. Sometimes the same general result
follows on the application of cold air to the outer mucous surface
— ^the skin, whereby the' blood is thrown on an extensive portion
of the inner mucous membrane of the nose, throat, and lungs ;
and then nearly the same phenomena are present, and a " fever-
ish cold" is said to exist. -But in either case, and indeed in all
cases of general symptoms, there is one organ, and sometimes
only one spot of an organ, that originates the whole series, and
which must be overcome, as the cause, before we can vanquish
the symptoms, which are the efiects. Too much stress cannot
be laid upon this important fact. The denial or ignorance of it
leads to the most unsciientific and unskilful treatment of disease
— ^it leads to the treatment of effects instead of causes — and, as I
•hall have hereafter occasion to show, it furnishes the chief argu-
ment against the ordinary drug medication of the day.

obterration of its caases, progress, and terminations can supply If space
permitted, it would not b« difficult to apply this doctrine to any possiUa

10 IX>CTRINB OF ACVTB DISBA8B.

It does not appear that, in acute disease of a part, the orgtmic
connection between the containing blood-vessels and their con
tained blood is further disturbed than to alter the vital chemistry
carried on in them, and thus to produce diseased nutrition or 8e«
cretions. There is no breaking down of the blood globules, no
disorganization of that fluid. There is only excess of blood in
vessels that have lost the sufficient irritability to contract <hi their
contents, and which yet, having this loW degree of vitality, are
exquisitely sensitive to the action of new or additional morbid
causes.

But this can only obtain lor a certain period. If the acute
inflammation be not terminated by some critical action in other
organs, — ^if no purging of the bowels, nor purging of the skin by
sweat,* nor of the kidneys by loaded urine, nor of the membrane
of the lungs by expectoration, puts an end to it by the transfer
of irritation to those several organs, the organic sympathy be-
tween the blood and its vessels is lost, and the other great organs
— ^the brain, spinal cord, heart, <Ssc. — which the first diseased
part had aroused to extraordinary action for the purpose of rescu-
ing' the organ in which it exists from disease, being unable to do
so in consequence of its intensity, fail in their powers too ; and
the death of the body follows.

Be it remarked, however, that we know not of death of the
body save as it is produced by failure of the organic powers of
the viscera-— of the internal parts. A man is said to die from
*^ mortification of the leg," when, in truth, he dies because the
irritation of the leg has. extended to the viscera, and, notably, to
the digestive organs, and caUses there a morbid state which kills
them. As long as they can digest food, the man will live,
though both legs were in a state of mortification ; and when they
will no longer digest food, the man will die, though only a single
toe were mortified. And if this holds with regard to the disease
of a limb, how much more forcibly is it true when some internal
malady alone is concerned ! In short, as I have elsewhere said,f
" death comes only hy the viscera ;" an axiom that ought to be
present to every physician when he visits a patient.

* Here is another of those terms which writers on the water-cure pro>
duce as new, uid containing a new idea. As in the case of the <* crisis,**
we must look back 3000 years to find Hippocrates speaking in many
places of his writings about ** purging by the skin."

t In my <* Simple Treatment of DiseaM.** Churchill, 1842.

DOCX&mS OF GfiBOfifIG 2»8BA8S. II

CHAPTER in.

DOCTRINE OF CHRONIC DISEASE.

PftMage of acute into chronic disease— How caused by drug medieatioii-
Imperfect and forced crisis produced by it — ^Loss of vitality in the blood*
vessels, a source of irritation to other parts— Parallel between the statet
producing acute and chronic disease — Changes of secretion and sensa-
tion illustrated in dyspepsia, chronic disease of the lungs, &c. — General
conclusion.

Supposing acute disease to terminate neither in death nor in
some complete critical action raised in another than the morbid
organ or set of organs, there remains a third termination of it-~
and that is " chronic disease."

To this the ordinary mode of drug medication in acute diseases
tends most po>verfully. I will endeavor to show how.

A simple inflammatory action of the stomach, such as I have
described in the last chapter, being endowed with the name of
'< acute indigestion," is treated as such ; that name is treated ;
the inflammation would appear never to b& considered — at least,
it is charitable to suppose so. For what is done ? Three or
four grains of a highly irritating compound of mercury, called
calomel, is administered, the aim being to urge the liver to pour
out its bile. Afler this has remained in the stomach for a few
hoars, violently iriitating it, and calling to its already gorged
mucous membrane a further supply of blood, another kind of
irritant is administered, in the shape of a purgative saline draught,
the Aim of iJuU being to cause the secretion of a vast quantity
of mucus from the whole digestive canal, and especially from
the stomach.

Now, in this process, two things are to be remarked : first,
J) at calomel does not simulate the liver to act, except by pre-
viously stimulating the stomach ; it acts, and can act only, by
extension of irritation from the stomach to the liver ; it never
SOuehes the liver at all — it is physically impossible that it should ;
and next, that neither can the liver pour oiit more bile than
usttal^ Qoi the.digestive mucous membrane pour out more miieui

>i2 DoinuNB or cBBome disease.

than usual, without more blood than usual being present, whence
to derive those secretions. Accordingly, after the double stimu-
lation of the calomel and the black draught perpetrated on the
membrane of the stomach, there can be no difficulty in imagining
the augmentation of blood in it. Yet the disorder to he removed
consisted essentially in an increase of blood in that very membrane /
Yet again calomel and black draught do certainly relieve a fit
of acute indigestion ! How is this ?

It is thus. It is found by long experience that a free flow of
bile and mucus from the digestive canal and liver is the kind of
crisis which Nature chooses in order to relieve the upper organs
of digestion. Autumnal diarrhoea is a never failing instance of
this. And as it is certain that, in acute dyspepsia, those upper
organs are disordered (however uncertain or erroneous may be
the precise notions of the disorder), the attempt is made to imi-
tate the natural relief by expediting it. An enormous quantity
of blood is attracted to the stomach directly, and to the liver indi-
rectly, and the vessels containing it relieve themselves by forcing
out the bile and mucus in extraordinary quantities. A forced^
false, and imperfect crisis is thus produced, and all seems quiet
again.

Seems quiet again ; for it is' impossible that such unnatural and
vehement stimulation can be applied to the organic nerves of the
mucous membrane without exhausting their energy ; it is the
law of all living bodies ; therefore, although the gorged vessels
have relieved themselves by their extraordinary secretions, the
nerves, by whose energy they should recover their healthy cali-
bre, fail to aflbrd such energy. In this state of things, nothing
prevents the accumulation again of blood in the same vessels :
the very first meal after the physic may do this, or it may be a
day or two of feeding, or a few days of mental or physical exer-
tion — for these, too, are causes of acute dyspepma. But ^hat-
ever the exciting cause, this second accumulation takes place
still more readily than the first, the oi^anic power of the part
having been weakened ; and, lo ! another fit of indigestion, and
the same calomel and black draught as before.

But this time it is not quite so acute in character as formeriy.
7he organic tone of the blood-vessels is. diminished, in conse-
<|uence of the exhausted state of their nerves. The organio
■ympatby beiween the vessels and the blood they contain is di*
ipinisi&edi frpiyi th« sanio cause ; add to which, that in the inter

DOCTBIIfB OF CHEOme DtSlASB. 18

Tftl between this and the ibrmer attack, the membrane of the
stomach has not been in condition to afford strong gastric juice,
digestion has been of a character not to make good blood, and the
want of this operates on the vessels of the diseased membrane.
So that, looking to the vessels themselves, to the nerves which in«
fluence them, and the blood that circulates in them, the whole of
the morbid organ, or part of organ, is in a still lower state of
vitality than before.

Nevertheless — and this must never be lost sight of— this dimin-
ished vitality in the portion of the diseased stomach is a cause
of great irritation elsewhere. The phenomena of headache,
fever, &c., are not so intense as before. But although the pain
of head, heat of skin, &c., are not such prondnerU signals of the
stomach disorder as before, this is because their vitality is dimin-
ished : they do not respond with the same vigor and acuteuess to
the digestive irritation as on the first attack. Still the mischief,
both in the stomach and the brain and its nerves, as well as the
skin, has advanced^ their minute action is further than ever
from the standard of healthy life. The two forced false and vn*
perfect crises have lefl the stomach in a more irritable, and more
ffjeble condition than ever.

But what of that ? Relief has been procured, speedily, and
with small trouble. Business and pleasure have scarcely, if at
all, been interrupted ; the only disagreeable has been the taste of
the physic, and perhaps a little griping of the bowels from it.
The patient knows not of, and the prescriber cares not for (if he
knows), the small spot of lingering irritation that is left behind,
to be again lighted up and again extinguished by forced deluges
of bile and mucus, until the stomach itself passes from irritation
into disorganizing ulceration, or cancer, and, extending its nnor-
bid sympathies to the brain, spinal cord, skin and lower bowels,
kills the patient with apoplexy or palsy, or allows him to drag on
life, a prey to the miseiies of hypochondriasis, to piles and rectum
disease, or to an inveteMte skin disease.

The mode in which this extension of morbid actions from the
stomach over the entire body takes place, will receive further de-
velopment in these pages. Meantime, the tracing of those actions
in the stomach itself, that has been made, will, I trust, put the
reader Jin possession of the organic state which constitutes chronic
disorder of the stomach. It will be perceived that it is an eztdu
sion, m degre$, of ths acute state* In both there i

14 DOCTBWB OF CBEONIG IM8SA8S.

3. The exhausted and relaxed condition of the blood- irefiaels.

2. The enfeebled, yet irritable state of the organic nerves of
the part.

3. The presence of an unusual quantity of blood in the vessels^
consequent on their loss of power to pass it on.

4. Disordered fluids from, and disordered nutrition of the part,
consequent on the presence of excessive blood, and on the imperfect
chemistry carried on in vessels that have lost the healthy control
of the ganglionic nerves, and the healthy sympathy with their
contained blood.'

In the chronic state of disease all these conditions are augmented.
The enfeebling and irritability of the vessels and nerves go on to
such an extent, that, in some cases, no interval whatever of re«
lief from the symptoms they beget is obtained. As regards the
excess of blood in the part, this varies with the amount of stimu-
lus applied. A more than ordinary amount of food, or drink of
stimulating quality, will, by exciting the contractility of the ves-
sels for a brief period, diminish the amount .they contain for that
period ; and for this reason it is that some dyspeptics find tempo-
rary ease from eating, from taking wine and other alcoholic
liquids, or bitters, or opiates. But it is mainly in the alteration
of the vital relations between the vessels and their contents that
the chronic stage of disease exceeds and differs from the acute.
In chronic disease, this relation is so lost, that the blood in the
vessels frequently breaks up, loses its globular constitution, be-
comes brown or purple, instead of vermilion, and is changed in
its chemical constitution also. As a consequence of all which,
the deposits from it, both liquid and solid, are more extensively
deranged than in acute disease, where the blood as yet retains its
mechanical, and is very slightly, if at all, changed in its chemical
characteristics. Hence it is that chronic disease (of the stomach,
for instance) is so invariably accompanied with acid instead of
insipid fluids, with vast volumes of air, sometimes insipid, at others,
foetid and oflensive ; the vital chemistry of the small blood- ves-
sels mixing together the elements of the blood in such a morbid
manner as to form acid in one case, and aeriform instead of liquid
matters in the other. Hence it is also that cancerous and other
simply morbid and malignant matters are deposited, instead of
the usual textures that constitute the part, be it the mucous mem-
brane of the stomach or of the lungs, the brain, the skin, and
Glhw textures.

DOiTBUnt OP SSBOMIC mUASS. 15

One of these solid deposits is the nervous matter itself of the
part. The loss of healthy structure and vital and chemical c(»i-
stiiution of the blood causes a deposit of diseased nervous matter
—matter that originates, therefore, diseased nervous sensations,
ilence the thousand indescribable sensations of the person afflicted
with chronic disease, especially of the stomach ; the material of
which his nerves are composed is diseased in kind. But he also
has it diseased in degree ; for there is an excess as well as a de«
terioration of blood in the part, and the deposit of nervous mate-
rial is, as a consequence, in excess too. Hence it is, taking the
stomach as an example again, that the food taken into a dyspeptic
stomach is generally felt^ which it never is in health ; a sound
man knows not, by his stomach, that he has eaten at all — ^knows
not that he has a stomach : the organic nerves in a state of health
not possessing sensibility, but only irritability. Hence, too, the
voracious appetite that accompanies some forms of chronic indi-
gestion, in which the excessive irritability of the nerves, from
augmented deposit of .nervous matter, causes an increased con-
traction of the muscular coat of the stomach, even to the amount
of spasm ; and hunger is nothing more than a gentle spasm of
that organ. In some dyspeptics, hunger of this kind is experi-
enced immediately after a very full meal. The same excessive
secretion of nervous matter also explains the extreme sensitive-
ness of the stomach to the sight and smell of many things which,
in health, were tolerable to both. And, finally, the combined
excess and deterioration of the nervous influence of the stomach
produces that immense caprice of appetite, and in the objects of
appetite, the fastidiousness and the desire for change, which cha-
racterizes some phases of chronic irritation of the stomach.

I have exemplified from this last-named chronic disorder, be-
cause it is the most familiar ; but the same doctrine applies to all
other organs of the body.

In chronic diseases of the air-tubes of the lungs, for instance,
which includes what are called << old man's cough " and " humid
asthma," the same Relaxation of blood-vessels and loss of accord
between them and their contents, beget morbid expectoration, on
the one hand, and excessive sensitiveness to the quality and
quantity of the air that enters them in respiration on the other.
There is frequently, too, the same caprice as regards air, which
. we have noticed in the stomach as regards food (for air is the
food of the lungs); and asthmatic patients will sometimes be aUe

' 10 SOCfftlNB OV CBR<miC mSBABE.

to breathe only the heavy and smoky atmosphere cf towns; at
others, only the elastic and light breezes of mountains.

Or suppose chronic disease fixed deeper in the lungs, in their
spongy texture ; there, too, the same condition of blood-vessels
and their contents gives rise to analogous results ; and the morbid
nutrition going on in the part leads to the formation of abscesses,
of tubercles, sooner or later to terminate in pulmonary consump.
tion, of cancerous deposit, of calcareous matter, &c., — all of them
dependent on morbid influence of the ganglionic nerves of the
part, morbid blood-vessels, and morbid blood.

From these instances all the rest may be conceived. In the
brain, in the heart, in the liver and kidneys, in the bones and
their covering, in the sheaths and great coverings of the muscles,
in the ligaments of the joints, and, finally, in the skin, the same
state forms the chronic disorder of each and all. Excessive and
morbid secretion, nutrition, and sensation, the result of exhausted
vitality of the blood- vessels, diseased blood within them, and ex-
treme but diseased sensitiveness of the ganglionic nerves of the
part, constitute the organic facts in these different textures and
organs of the body.

I now proceed to review the manner in which a combination
of points of chronic disorder is brought about, and from a simple,
becomes a complicated disease*

ucmwioif OF oHBOHic mmuam* 17

CHAPTER IV.

PHEN(»IENA OF THE EXTENSION OF CHRONIC DISEASE.

Oocasional and permanent extension — ^Agency of the nertoui •yftem in
this — Animal sensation not necessary— Rationale of extension withoui
pain — Shown in congestion of the hrain— Phases of extension — Why
without pain — ^Exemplified in various stomach disorders — Extension ftom
•tomaeh to liyer— From the same to the air-tobes of the lungs — ^Stomach
cough^Aflthma^Pulmonary consumption — ^Extension to the kidneys,
stone, diabetes, dropsy, Bright's disease — Extension to the skin, tetters,
scurf, acne, &c. — To the limbs, spurious palsy — Sympathy of nutrition —
Importance of the viscera— Extension from without inwards, wounds,
&c.— From within outwards, toith pain — Gout, tic, rheumatism, &c.—
Causes of the pain^Generalizations.

i HAVE hitherto been speaking of the minute essentials of chronic
disease in any one organ, or part of an -organ. The chief cha.
sacteristio of a living body, however, Sympathy, will not admit
of one part remaining in a morbid state, without involving, sooner
or later, other parts. The principle upon which this proceeda,
and the phenomena elicited in the course of the extension, are
of the first importance in guiding us towards the philosophical
treatment of disease. The want of precise ideas on this subject
Is the source of the most inefficient, and, at the same time, of the
most dangerous practice in chronic disorder ; of practice which
strives against effects, instead of causes, and ends by exasperating
both, as I shall show in the next chapter.

The extension of chronic disease is either occasional or permO'
nent; and the frequent repetition of the former leads to the
latter. Thus chronic irritation of the liver and stomach causes
occasional flushing of the face, and headache, — vindications of
surging of blood towards the head, — the intervals between which
gradually become less and less palpable, as the establishment of
the condition in the head which causes them proceeds. It is a
sort of warning given before another organ, the brain, becomes
permanently involved in the mischief of the one first afiected.

The agent by which this extension takes places is the nervous

18 EXTB1I6KXN OF GBBOKIC DHEASB.

' system ; but both occasional and permanent eict^nsion may take
place without the intervention of animal sensation — as when
chronic irritation of the digestive apparatus causes a periodical
increase of discharge from an external ulcer, no increase of pain
or other sensation attending ; or when irritation of the stomach
acts slowly but incessantly on the heart, producing therein or.
ganic mischief totally unsuspected, until examination afler a
sudden death reveals the fact of long-standing disease in both
organs. Very frequently the worst cases of indigestion are those,
which produce no pain, no malaise even, but in which the body
wastes in atrophy. The deposit of tubercles in the lungs from
chronic disease of the digestive organs is another and tcx) fre-
quent illustration of this fact. In such cases there must still
be transmission of sympathy, of sensation ; and, inasmuch as
the animal part of us is not aware of the transmission, save by
its results, it follows that the sensation propagated from one dis-
eased part to another, must have been an organic ^en^a^ion, as
ccmtra-distinguished from an animal one.

Referring to the fact before-mentioned, that wherever there is
a blood-vessel, or whereyer nutrition goes on, there are organic
nerves, the explanation of this organic sympathy or sensation
will be sufficiently clear. The universality of these nerves and ,
blood-vessels in the body renders the extension of organic irrita-
tions from one of its organs to others a very ready, and, indeed,
an inevitable phenomenon. The exhausted and irritable nerves
and vessels of a part prove, as was before said, a source of irri-
tation, of stimulation to other parts. In these latter, the same
minute changes go on as have been observed in the part first
affected— -oft-repeated contraction, followed by relaxation and
exhaustion of the vessels and organic nerves. Thus, in the in-
stance just quoted, the chronic irritation of the stomach from
time to time violently stimulates the blood-vessels of the brain ;
these contract vehemently, then relax, and then the blood surges
towards the head to fill them. This process happening over and
over again, the vessels of the brain become at length permanently
gorged, congested; and congestion of the brain may terminate in
partial pressure of its substance, and consequent palsy of a limb
or of half the body : or the congestion may end in disorgatuzO'
Hon ofihe brain, insanity , imbeciUty, and death.

As may be readily conceived from what has been premised,
the shades of this irritation and congestion are infinite. They

EXTBNStON OF CHRONIC DTSEASS. 19

vary with the amount and character of the first-formed irritationi
with the predisposition of the part secondarily affected^ and with
the general temperament of the individual. Thus, in the case
of chronic stomach irritation extending to the head, the phase of
mischief in this last will depend upon the long or short standing
of the stomach disease; upon its exasperation by food or physic ;
upon the predisposition caused or avoided by the palient's toil or
ease of brain and mind ; and upon the fact of his having a largely
developed brain or otherwise. These various phases produce
and represent respectively simple fulness of the heady impatience
and irriiabiUty of temper, hypochondriasis, insanity, apoplectic con^
gestionj paralytic congestion (I shall speak of the difference be-
tween these two states afterwards), annihilation of the mind in
drivelUng imbecility ; so that a simple fit of acute indigestion in
the stomach may, by improper management, grow into a chronic
dyspepsia, and terminate in idiocy ; and this is an almost every-
day fact?

I repeat, then, that the most extensive changes in organs may
be brought about without the intervention of animal sensation or
pain ; and this because the ganglionic nerves, which alone pre-
side over the offices of the blood-vessels, are concerned in, and
are capable of themselves of effectihg those changes. The most
serious ulceration of the stomach and bowels — nay, cancerous
ulceration of that organ — may go on without the smallest amount
of animal pain ; but far more fortunate are they in whom such
pain is excited at a very early stage of mischief, for they are
thereby warned from indulgence in its causes, and cautioned to
remedy it ; whilst, in the other case, the very core of life may
be unsound, the vitals undermined and beyond remedy, before
the opportunity of applying any is given. How often have I
seen medical men pronounce positively the absence of all in-
flammation of the digestive organs, because pressure on them
•^ith the hand elicited no pain / and this at the very time when
apoplectic fulness of the head from extension of chronic irritation
of stomach kept the patient tottering on the brink of the grave,
yet was speedily relieved by hot fomentations over the stomach,
and spare diet.

The fact is, that the nerves of organic life neither are obedient
to the will, nor capable of sensation in the ordinary acceptation
of that term. On the other hand, they urge and modify both the
will and the sensation of our animal nerves— 4hat Is, of our iMPaiii,

26 SXTBMSIOH OP CHROmC DI8BA8B.

spinal cord, and their nerves — ^inasmuch as these are nourislied
by blood and vessels over which the organic nerves hold sway ;
and their state of acuteness or dulness, of firmness or flightiness,
depends on the way in which they are nourished. By virtue of
this it is that we constantly see chronic stomach disease playing
by sympathy so much upon the nutritive vessels of the brain as to
induce at one time the most vehement will of fiendish impatience,
and at another time prostrating it in the hopeless irresolution of
hypochondriasis. By virtue of this it is that the most minute
changes in the digestive parts act upon the brain and mind, no
animal sensation intervening, unfounded fears, anxieties, and
imaginary diseases tormenting the soul, and keeping up the dis-
tresses of that malady. By virtue of this it i& that food sweetens
the temper which hunger had acidified ; and that the best tinie to
ask a favor is afler — the worst time before — dinner. By virtue
of this it is that chronic irritation of the stomach is so frequently
attended with dreams generally of an appalling or distressing
character, and that the sleep in such cases is so oflen unrefreshing.
All these states are owing to the morbid nutrition of the brain
swayed by the morbid action of the ganglionic nerves, and the
blood-vessels that pervade its substance. But all these may exist
without pain.

Again, the chronic irritation of the stomach may creep on
towards the liver without the smallest intervention of pain. The
same membrane that lines the former passes on to line all the
myriad bile ducts of the latter, and is supplied with enormous
quantities of ganglionic nerves, and very sparingly with nerves
of animal life. . Hence it is that very frequently pains are ex-
perienced in the right shoulder, in the head, and appear in the
form of fee douloureux of the face, arms, fingers, and thighs, that
are clearly traceable to chronic irritation of the liver, in which
organ itself, meantime, not a sign of pain has been experienced.
The explanation of these sympathetic pains will be givon by
and by.

Or take the instance of chronic disease of the air tubes of the
lungs, or *' old man's cough." This may go on to a most distruc-
live extent without any pain whatever. The outpouring of various
kinds of expectoration from the diseased blood-vessels of the
pulmonary mucous membrane into the air tubes may produce a
s^se of oppression, or a tickling, that brings on the instinctive
act of coughing ; but there is no ache nor pain in this ; besides,

XXTSHSION OP CU&ONIC DISBAflE. M

if there were, it would rather be from the consequenoes 0t the
ehronlc irritation — ^the fluid to be expectorated — ^than from the
irritation itself, that it would proceed. Nay, in the most formida-
ble of all lung diseases — futmonary consumption — ^the whole malady
may be enacted, from the formation of tubercles to the last attempt .
at expectoration, without pain of the chest. .

Not to multiply instances, I may mention that huge fatty tumors,
bony tumors, and even cancerbus tumors, 41II of them the resuUa
of chronic irritation, may be deposited without animal pain of the
part.

Pain, therefore, is not 4 necessary concomitant of chronic dis
ease of an organ, and of its extension to others. It frequently is
an accompaniment, but not necessarily so. An important mazim^
the denial or ignorance of which tends to that disastrous system
of stimulation, which is at once the producer and the maintainer
of chronic disease. Denying the existence of irritation and in-
flammation where no pcdn can be elicited, the ordinary plan of
proceeding is to stimulate, on the ground that what is not inflam-
mation must be want of tone. From what has preceded, the
reader will perceive that chronic inflammation is, quoad the blood-
vessels, want of tone, but also, quoad the ganglionic nerves, ex-
cessive sensitiveness. I shall amplify this point when speaking
of the causes of the extension of chronic disease.

Extension of chronic disorder is not confined to adjacent organs*
Perhaps we may even say, that it more commonly takes plac#
towards organs at a distance. I have already quoted the case of
chronic stomach irritation being propagated to the brain, and it is
one of the most frequent occurrences. I have also alluded to the
non-painful extension to the heart.

Another instance is the propagation of the same stomach malady
to ike lungs, aiHi this is of twp kinds. One degree of the first
malady excites and maintains in the mucous membrane of the
pulmonary air tubes 'a chronic condition of extreme sensitiveness
or morbid secretion, and sometimes of both, which renders those
parts exceedingly susceptible to alternations of temperature, and
thus is incessantly causing the patient to catch fresh colds, besides
maintaining, in the intervals, a dry, hard, ringing cough, well
known as stomach cough. The frequent repetition of the catarrhal
attacks of the air tubes alluded to, at length ends in the establish*
ment of a chronic inflammation therein, attended with a varying,
but always some amount of expectoration ; and thus what was at

B2 EXTENSION OF CHRONIC I>I8£ASS«

first only a nervous irritation, begetting a sympathetic oough^ enda
by a substantial chronic inflammatory congestion. In this con-
gestion, induced by sympathetic extension from the stomach, we
behold one of the elements that enter into that complicated malady
called asthma, which I shall notice hereafter.

A second degree of chronic stomach irritation propagated to the
lungs tends to the formation of tubercles, and the commencement
o£ pulmonary consumption. In this instance, the phase of irritation
is such as to excite a sympathetic irritation in the spongy tissue
of the lungs, not in the air tubes. The minute changes consti-
tuting chronic disease, so often spoken of in these pages, will go
far to explain the deposition of tubercular matter in such a case.
But this is not all. In most persons in whom tubercular con-
sumption obtains, there is a congenital disposition of the circulating
blood, which tends to such deposition in any tissue of the body, as
we behold in white swelling of the Icnee and elbow, which are nothing
more than inflammation of tubercles deposited in the bones of those
joints. Now, the organic sympathies between the stomach and
lungs being great, from the vast quantity of organic nervous mat-
ter they both contain, the deposition in question takes place more
frequently in the lungs than elsewhere. The fact is, meantime,
that the process of digestion in the stomach, which produces the
constitution of the blood alluded to (a constitution commonly
known as scrofula), is rendered a morbid process in consequence
of the chronic inflammation always going on there ; for never was
there a patient laboring under tubercular deposit in the lungs who
had not previously to, and concomitantly vrith it a chronic disease of
the stomach, I put this down as an invariable fact, and am ready
to prove it in any case that may be submitted to me : so that
chronic stomach irritation acts in two ways in the production of
pulmonary consumption.

1st, By establishing, through the sympathy which exists be-
tween all parts of the organic nerves, an irritation in the spongy
texture of the lungs — a state which, of itself, supposes a morbid
condition of the circulating blood in the chronically diseased spot,
but which, in this case, is further rendered morbid by

2d, The morbid state of the whole blood of the body, result-
ing from the imperfect digestion of food in a stomach in a state
of chronic disease.

As I have already remarked, this extension of chronic disease
may, and generally does> take place without the slightest pain.

SXTBN8I0N OF CHRONIC PiaSASS. St

Uhronio irritation of the stomach, in which the liver is also
Qsually involved, also takes an extension towards the kidneys, in
which an action is consequently set up, and a kind of blood ge-
nerated, both generally in the body, and particularly in the kid-
ney, that produces a secretion of variously disordered urine, but
the chief varieties of which are the acid, the albuminous, and
the saccharine. As results of this extension, we have to note
three formidable maladies — stone and gravel, BrigkCs diseasCf
and diabetes. Another disease, dropsy, very often attributed to
the kidneys alone, I shall, further on, show to be connected
rather with malady of other parts, and notably of the blood-
making organs, the stomach and lungs.

There are some extensions of chronic disease of the stomach
to the skin that take place without pain or other animal sensation.
Several kinds of tetter come under the category, especially those ^
of the dry kinds, which are marked by an excessive secretion of
skin, causing the scuff that so oflen prevails in patches over the
body.

The skin complaint, technically called acne, and which con-
sists in the presence of small pimples with white heads, scattered
oyer the shoulders and forehead, and thickly ranged on the chin,
is, for the most part, unaccompanied with pain or other sensation
in its character of an extension of chronic irritation of the diges-
tive organs ; for that it is such is abundantly proved by the whole
history of the disease, as well as by the operation of diet and
other medical means applicable to the stomach upon it.

As regards the extension of chronic disease of the digestive
organs to the limbs, without the presence of pain, there is only
one form of such extension ; and even this, though frequently
unaccompanied by pain, has the animal sensations of lassitude,
tremblings, heats, &c. I allude to the gradual failing of power
over the limbs, swelling of the joints, spasmodic drawing of the
muscles that bend the limbs, and final distortion and fixation of
them; the whole being the result of an intense, destructive
irritation of the digestive organs, deterioration of digestion and
blood-making, and consequent bad nutrition of the whole body,
the animal nervous system especially. I shall have to speak
of this condition at some length when treating of the causes of
chronic diseases, as also when the individual diseases come to
be considered. Meantime I shall mark it by the .name of jpn-
rJoiM palsy.

M SXTINSIOIC OP CRBONIC DtnAlS.

In the instances enumerated, wherein no animal
companies the extension of chronic disease from the stomach in
all directions of the hody, that extension is accomplished by the
universal sympathy of nutrition, as it is carried on under the
influence of the ganglionic nervous system. But, though univer-
sal, that system has a centre in which the greatest masses of the
matter constituting it are congregated, and towards which irrita-
tions commencing in any part of the body converge ; just as,
when ihey commence in the stomach, they diverge to all other
parts of the body. That centre is to be found in the ganglionic
networks and nuclei that abound in and surround the viscera, and,
in a more especial manner, in that portion of them which regu-
lates the offices of the upper organs of digestion, the stomach and
liver. All the facts of healthy, as well as those of diseased life,
confirm this doctrine. In the organs of digestion we behold the
starting point of all the nutrition of the frame : according to the
vigor they exhibit b that of the other viscera, of the brain, and
of the limbs ; and when these are wearied by exertion and the
natural waste, they transmit to the stomach organic sensations
that produce in it the craving for supply, which we call hunger,
and.the first act of restorative nutrition, which we call digestion.
Suppose this digestion to be bad, what follows ? Imperfectly
formed blood : whence comes bad nutrition of parts — bad solids
and fluids ; the solids weak and irritable, the fluids morbid and
irritating ; and both send back their irritations to the parent mis-
chief in the stomach. In short, there is a sympathy of nutrition
going on between all parts of the body, independent of the animdl
sympathy commonly spoken of; and whilst the latter has its cen-
tral points of convergence and divergence in the brain and spinal
cord, the former — ^the sympathy of nutrition — has those points in
the ganglions and net-works of nerves of organic life that exist
so largely in the immediate neighborhood of the primary organ
of nutrition, the stomach.

When therefore disease, commencing in an acute form in any
of the organs or tissues of the body, passes into the chronic state,
an organic sympathy is established with the centre of organic
life in the stomach ; and according to the condition of the stom-
ach will be the intensity, the duration, and the curability of the
local chronic disorder ; for the stomach sends its organic sensa-
tions back to the morbid part. The smallest patch of skin dis-
ease on the leg or arm is maintained in its chronic state by some

BXnUfSION OF CHEONIC DSSBAMB. 26

ttaalogous irritation in the great digestive organ, and is, in faot|
a symptom of the existence of such irritation. A broken bone
will not unite, neither will an external ulcer heal, if there be
chronic disease of the stomach going on — ^the fracture and the
ulcer become chronic too. In short, we know not of chrome
disease of any part of the body without some phase of the same con*
dition in the nervous and other Ussties of the stomach ; this is an.
unvarying rule. And though in many cases appetite may be
present, digestion free from uneasiness and apparently perfect,
yet will the distant malady never be got rid of, so long as reme*
dies that act upon the digestive organs, to reduce irritation, are
avoided. Abebnethy knew this well ; but, inasmuch as he
failed to appreciate the true meaning of chronic digestive disor-
der, and the process and agent of organic sympathy, the remedies
he applied rather transferred than extinguished, and even, in the
long run, exasperated, the malady they were directed against.
[ shall exemplify this when treating of the causes and progress
of chronic disease.

Whilst thus the extension of chronic disease is in many in-
stances from within outwards, commencing in the digestive parts, .
and radiating in all directions ; and whilst, on the other hand,
irritation commencing in some external part is propagated by
sympathy towards the digestive organs, it will depend upon the
condition of these last how long and how severe the disease shall
be in the first case ;* and whether, in the second case, the exter-
nal irritation shall become chronic at all, and how long it shall
remain so.

For, suppose a lacerated wound of the leg. It sends organic
irritation to the stomach. If the stomach be in a sound condition,
it will be able to re-act upon the irritation, and, by virtue of its
good digestion, send to the wounded spot blood of a healthy and
healing character. The consequence is that, between the ab-
sence of irritative re-action from the ganglionic centre and the
presence of healthy blood to throw out the matter that is to unite
the wound, the latter heals without inflammation. Had the irri-
tation of the wound found the nerves and blood-vessels of the
digestive parts chronically diseased, all this would have been re-
versed : the wound would have remained open and chronically
irritated ; that is to say, the same diseased blood, blood-vessels,
and secretions, and the same diseased sensations, would hav0
8

16 EXTBIISION OF CHROlfIC DIS&ASB.

perraded it, just bo long, and no longer than the stomach i^
mained in like state.

But further, the irritation commencing without may induce
ehronic disorder of the stomach, which, as in the former instance,
maintains the external mischief. Thus, a hlow is given on the
knee-joint ; a shock is given to the stomach in consequence ;
vomiting ensues ; this acute-irritation of the stomach passes into
a chronic state, and then commences that interchange of irrita.
tions which (exasperated by the ordinary treatment) is so often
found to terminate in amputation of the limb. Of course, in this
and all similar cases, the whole series of phenomena will depend
upon the violence of the first irritation : if the blow be not very
severe, and the stomach sound, the latter will triumph, and no
chronic disorder of the knee will be established.

To return to the extension of chronic disease from the digestive
organs to the outer organs. This would appear to be done in not
a few occasions as an attempt on the part of the inner and vital
part to throw its mischief on some less important external part.
Strictly speaking, this is scarcely extension ; it is rather a trans-
fer. Yet as it is rarely, if ever, accompanied by a total transfer
of the stomach malady, it may be here referred to ; the rather as
it is an important and frequent phenomenon in the course of many
chronic diseases. In aciUe disease, the same phenomenon is ex-
hibited in the eruptive maladies, measles, smalUpox, scarlet-
fever, &c., which are but efforts of the violently irritated internal
parts to throw some part, at least, of their mischief upon the skin ;
in doing which they involve the animal nervous system, the brain,
and spinal cord. But in the chronic form, the extension takes
place more slowly, and a skin disease of some kind, or an ulcer,
is gradually established as a sort of counterpoise to the irritation
which wo aid otherwise prey upon the vital parts, and destroy
them* That something of this obtains is plain from the fact, that
whenever these chronic skin diseases or ulcers are driven in, or
dried up, many serious results follow in some important viscus,
such as apoplexy of the brain, spasm of the heart or stomach,
spitting of blood from the lungs, &c. It is well known that Na-
K>LB0N had a patch of skin disease on the outer side of one of
his thighs ; and that whenever he felt heavy, or melancholy, or
more than usuc^lly Irritable in mind, and uneasy in body, he had
enly to coax a further amount of irritation into this patch, by
scratching until two or three drops of blood came, to find im»

BZT£1CSI0N OP CHBONIC DISEASE. 27

BBediate relief. And this necessity arose whenever the skin dis^
ease had diminished in degree; that is to say whenever the
disease within had become more concentrated and intense.

Sometimes this extension to the surface of the body only takea
place at certain times, the internal chronic malady, meantime,
always remaining there. Thus many persons have eruptions oi
various kinds in the spring or in the autumn. Others have ful-
ness of the mucous membrane of the nostrils, and bleeding thence
at periods depending on the accidents of the patient's mode of life.
Others again have painful itching and bleeding hemorrhoids
whenever the smallest aberration from cool diet is permitted ; and
not unfrequently, without any such causes working, internal
ehronic disease takes this mode of relieving itself by the extension
from time to time to less important parts. One of the most harm-
less, but at the same time the most troublesome, instances of the
occasional extension of chronic stomach disease, is the tenderness
of the feet, so often complained of by dyspeptic patients. SwelUng
cf the feet is another instance. Sound stomachs are subject to
neither of these evils.

Under this category of extension to the external organs of the
body, come the important diseases, gotU and rheumatism. Here
the extension is accompanied with the phenomenon of pain, as it
also is in another too prevalent disorder, which is also an exten-
sbn of internal chronic mischief — I allude to Uc douloureux in its
various shapes of megrim or nervous headache^ toothache, sciatica,
tie of the face, of the fingers, SfC,

Pain in these cases is attributable to the peculiar phase of the
internal irritation, to its fixing on a peculiar tissue, and to a cer«
organization of the individual.

The phase of internal irritation is generally of the most invete-
rate character ; the loss of power on the part of the blood-vessels
and ganglionic nerves would appear to be extreme, for in no
series of maladies is it mastered with greater difficulty than in
those just named. Moreover, the mingled feebleness and irrita-
bility of the ganglionic nerves so often referred to, would seem to
be excessive, since causes almost inappreciable suffice to rouse
&e lurking irritation to the point of producing pain. And this
mingled morbid state causing a similarly irritable condition of all
the nutritive nerves and blood- vessel"- over the body, will account
fi>r the exquisite sensitiveness of gouty, rheumatic, and tic pattents
to the smdlest change in the atmospheric and telluric influences

28 EXTENSION OF CHRONIC DISEASE.

A cloud passing athwart the sky is often felt by sufferers from tUf
who will also tell you how the wind has changed in the course of
the night, or that snow wilj fall in ten or twelve hours before
there is to others the least sign of it. The same may be said of
gouty-rheumatic persons. And in both maladies there is a readi-
ness to take cold that can only be accounted for by the enfeebled
action of the vessels and nerves that minister to the nutrition of
parts, on one hand, and to the morbid sensitiveness of the nerves
of the brain and spinal cord distributed to the skin, on the other.

The peculiar tissue affected in internal chronic disease, which
exhibits itself in gout, rheumatism, and tic, is more especially the
nervous tissue of the stomach and liver ; that is to say, there is
rather irritation and congestion of the ganglionic nerves of those
parts than of the mucous membrane : for it is very common to
find the tongue perfectly clean in the worst cases of the diseases
in question. No doubt the fnucous membrane is, in many in-
stances, involved also; but. that is not an essential of the state I
am speaking of. Now, it is a well-established law of the economy,
that similar tissues have the strongest sympathies ; and it is a well-
established anatomical fact that a large portion of the spinal cord
(that portion of it which ministers to sensation) is very similar in
texture to the ganglionic nerves of the viscera. Accordingly,
these last being inordinately irritated, a sympathetic irritation is
roused in the spinal cord, and therefore, in more or fewer of the
nerves which proceed from it, and are distributed to the joints
and muscles of the body ; — if in the nerves of the face, producing
the most usual form of tic ; if in the great nerve of the thigh,
producing sciatica ; and if generally to the superficial nerves of
a limb, producing neuralgic rheumatism of that limb ; but in
rheumatism, and gout, and tic, alike, there is the further organic
irritation, originated and maintained by the sympathy between
the ganglionic nervous matter of the viscera, and that of the par-
ticular limb, joint, or nerve, tha*; may be respectively the seat of
the rheumatic, the gouty, or the tic pain ; so that the irritation
radiating directly from within to the outward point of disease, and
again radiating firom within to the spinal cord, and thence by the
animal nerves to the same outward point, these diseases are with
much propriety stigmatized as complicated, and dreaded as in-
tractable by most medical practitioners of the ordinary treatment.

Lastly, the pain in these maladies is attributable to indlTidual
organization ; in other words, the reason why some persons haviiig

EXTENSION OF CHRONIC DISEASE. 39

visceral irritation are more liable to have it thrown upon the ani-
mal nervous tissue, inducing the pain of gout, rheuraatism, and
tic, than other persons having the same internal irritation, is to be
sought for in the greater development of the animal nervous sys-
tem (especialiy of the spinal cord), in the former. In proof of
which, we find that the great majority of those who are liable to
those diseases, either have been (before they were crippled), or
are, given to the strong exertion of the will in the shape of strong
exercise : the spinal cord being, let it be remembered, the seat of
the will, which is exercised by its nerves sent to the muscles of
the whole body. In tic, more particularly, I have remarked that
almost every patient is possessed of a vehement will, and of hard
muscles on which to exert it ; and both in it and in rheumatism I
have observed the characteristic energy of those afflicted with
either. You never see a phlegmatic nature attsicked by rheuma-
tism or tic, and very rarely by gout.

In the extension, then, of chronic visceral irritation in the ibrms
•f rheumatic, gouty, and neuralgic disorder, we have still the
phenomenon of organic extension ; that is, from the centre to the
circumference of the ganglionic system of nerves ; but we havoi
in addition, the phenomenon of pain, indicative of extension from
the same visceral irritation to the spinal cord, producing therein
an action which is the cause of the pain experienced in the exter-
nal affected parts. Let both these facts be well borne in mind ;
they bear much on the scientific treatment of the diseases in
point.

As in the instances just considered, the chief extension was to
the spinal cord and its nerves, so in another series of phenomena
connected with the animal nervous system, the extension is par-
ticularly to the brain. These phenomena are collectively called
nervousness, or neuropathy, and may be sufliciently intense to de-
serve the names of monomania and insanity. In the former, the
amount of irritation in the ganglionic centre is not so extreme as
to maintain, though it is sufiicient to generate, an irregular circu-
lation in the brain. Hence we find that nervousness is brought
into play by surrounding circumstances ; the patient being tole-
rably free from it if withdrawn from external causes of excitement,
and prevented from the strong exertion of the will. But in mo»
aomaniacal and general insanity, the brain circulation of blood is
pennaaently deranged, the ideas are continuously confused ; wad
both indicate a degree of chronic ganglionic irritation in the abda*

ISO EXTSKSJON OF CHRONIC DISEASB.

men that is of the most intense character. In these neuropathic
and insane instances, as in the neuralgic states last spoken of, a
certain organization of the brain, for the most part, obtains, which
renders it obnoxious to the radiation of the ganglionic irritation to
its own tissue rather than to other textures of the l^dy. Whilst,
however, this is admitted, it must not be supposed that in these
unfortunate conditions the brain alone is concerned ; both one
and the other are muoh more essenfially maladies of the nerves of
the abdomen than of the brain, the facts and arguments in favor
of which I have fully stated in my work, entitled "-4n Exposition
cfihe Symptoms, Essential Nature, and Treatment of Neuropathy,
or Nervousness. ''*

This sketch of the mode of extension that obtains in chronic
dfseaSe points to a few generalizations which it is important to
mark, as in the appreciation of that form of disease as well as in
its treatment, they should ever be prominently present to the
mental eye of the medical practitioner.

Ist. Chronic disease may exist, and its extension from one to
several organs may take place, without the intervention of ani-
mal pain.

2d. In such cases, the organic or ganglionic system of nerves
is alone concerned, and the extension is effected by the organic
sympathy which exists between all the tissues of the body by
virtue of their common nutrition from the same mass of circu-
lating blood ; of which sympathy and nutrition the nervous sys-
tem in question is the representative.

3d. Chronic disease may exist, and its extension from one to
several organs, may take place with animal pain.

4th. In such cases, the ganglionic irritation has been more
especially fixed in the purely nervous tissue of that name dis-
tributed in the abdomen, and has produced a sympathetic irritation
in the same nervous matter distributed to the blood-vessels which
nourish the animal nervous centres, the brain and spinal cord ;
the consequence of which is pain of more or fewer of the nerves
proceeding from these last to the various external and internal
parts of the body, constituting neuralgic diseases ; or unnatural
sensations and perceptions of a temporary character, constituting
the various shades of nervousness ; or, lastly, perverted ideas of

* In 1 vol. 8vo.» second edition, 1842. Churchill, Princes street, SohOa

JBXTSNSION OF CHRONIC DISBASB. SI

a permanent character, constituting the various shades of menial
insanity.

5th. Disease, of what part of the body soever, is endued with
the chronic character, and maintained in it only by some chronic
irritation in the central portions of the organic system of nerves,
and notably in those portions that are found about the stomach
and liver. Whether the starting point be in the skin or brain,
or digestive organs themselves, there is no chronic disease without
the implication of these last. If they be sound, the causes of
disease applied elsewhere, in distant parts, are resisted and over,
come ; if they be inclined to disease, those causes act indirectly
upon til cm, and, through them, establish disease in the distant
part.

6th. The extension of chronic disease from the internal to
the external parts is usually made for the purpose of relieving
the former, which are immediately necessary to life, at the ex-
pense of the latter, which are less so. And this is done either
periodically, as in goutf tic, 62c., or permanently, as in chronic
rheumatism, skin disease, &oc. Of the rationale of this efibrt at
relief we know little ; and in this want, it has usually been as-
cribed to the restorative power of nature — ^the vis medicatrix
naturcR of the schools.

No allusion is made in the above 5?tatements and conclusions
to the doctrine of chronic disease advanced by Liebig, because
that doctrine applies only to the chemical changes that occur,
and because these are, in a living body, necessarily secondary to
the vital changes, upon which I have more especially built. In
the appendix, reference will be made to the applications of Libbig's
theory to the treatment of chronic disease by the processes of
the water.cure.

83 THS CAUSES, PR06a£SS, AND

CHAPTER V.

THE CAUSES, PROGRESS, AND TERMINATIONS OF CHRONIC
DISEASE.

Constitutions that predispose to chronic disease — The ganglionic and scro*
fulous constitutions— Previous disease— Bloodletting as a cause — Drug
medication in acute disease — ^How it causes and maintains int^nal
chronic disease — Note on homoeopathy — How external chroiftc disease
is kept up— Stimulating diet — Care — Intellectual labor— Progress and
peculiarities of chronic disease — Occasional exasperation into an acute
form — Termination in organic disease— Act of death in chronic disease.

Having, in preceding chapters, entered into the minute conditions
constituting chronic disease, and traced its origin, I shall, in the
present one, inquire into its predisposing causes, and trace its
progress towards the various terminations to which it is liable.
In doing this, I shall suppose that the minute conditions alluded
to, as well as the mode of extension, are understood from what
has been already advanced, and shall therefore have no occasion
to repeat them, but may speak of them in a more general Ian-
guage. Having explained terms,- it is logically correct to use
them.

There would appear to be a decided predisposition towards the
establishment of chronic disease in certain constitutions — ^that is
to say, acute disease has a greater tendency to become chronic
in some than in other persons. What this constitution is, may,
perhaps, be hardly pronounced by an epithet. The scrofulcma
constitution may be signalized as peculiarly liable to fall into this
form of disease. But there is another organic disposition which,
without the distinctive characteristic of scrofula towards glandu-
lar disease, consists in a feebleness of the nutritive digestive
organs that induces the formation of solids and fluids of the body
that are unequal to the strong and sustained reaction against ex-
ternal things, which is the fortunate prerogative of the healthy.
Persons in this state may almost be said to have a cgngenital
chronic disease ; for in them, at their best, we behold the ma-
jority of the symptoms of chronic irritation of the stomach and

TEBMIITATIONS OF CHRONIC DISEASE. 88

bowels. There is the clean and very red tongue, sometimes split
and too large ; enlarged tonsils of the throat ; gorged eyelids ;
lips almost purple with congestion ; breath more or less ofiensive ;
appetite keen but small, with rapid swallowing of food ; sinking,
and incapability of going long without food; obstinate bowels.
These persons are, in their exterior, unlike the £csrofulous, in
tending rather to emaciation than puffiness and fat (except that
the abdomen is often large) ;. in being more frequently dark than
light-complexioned ; in their tendency to vivacity rather than
slowness of feeling and expression. They are nervous and
fidgety ; excessively anxious about all they are or are not concerned
in ;- are for the most part bad sleepers, and wake with a sense
of sinkiqg. They are very much given to take cold, especially
that form of it called inflitenza, and also sore throat. They do
not so commonly fall into pulmonary consumption as the scrofu-
lous, though they are liable to it. On the other hand, they ex-
hibit in all their intensity the various affections of the limbs
which, ordinarily treated as rheumatism and rheumatic gouty are
resolvable into forms of neuralgia, the sympathies of the abdomi-
nal viscera being, in this disposition, established more especially
with the brain and spinal coi-d! Finally, they do not appear, as
in scrofula, to inherit or propagate the constitution in question.

To this diathesis, or disposition (I do not call it temperament^
because that depends on the whole organization viewed congeni-
tally, and is not alterable by any plan of treatment)! I would
apply the term ganglionic — the ganglionic constitution, inasmuch
as it consists essentially in a chronic congestion of the viscera,
and of the nervous centres of that name situated among the
viscera.

From what has been said in former chapters, it will not be
difficult to comprehend wherefore this sort of organic congestion
tends to drive acute into chronic disorder, and to maintain the
latter in any part of the body. In fact, the centre of nutrition
being at fault in its function, the extremities are deficient in that
energy which can alone accompany soundness at the core. Al-
most the whole blood of the body is accumulated in the viscera,
and but little remains for the surface to enable it to resist and re-
act upon external agencies of temperature, electricity, &c. Ac-
cordingly, we find in such constitutions, besides the liability to
catarrh already alluded to, an acute sensitiveness to variations of
•tmospheric electricity, the spirits, strencrth. sleen. &c.. vpnrina

M THB CAUSES, PBOQHB8S, AND

wUh almost any oloud that passes oTer the sky, and with evvry
change of wind. By virtue, also, of the strong sympathy thai
exists between the viscera and the brain and spinal cord, we find
in this state many signals of irregular and painful function in the
latter parts, such as the anxiety and fidgety character of mind
before-mentioned, and, as regards the physique, a strong tendency
to spasmodic and neuralgic phenomena of the limbs. Doubtlessly
to this cause is to be attributed the sensitiveness to electric changes,
since these infringe upon the delicate extremities of the nerves
of the spinal cord so thickly spread over the whole surface of the
body. The individual, in short, is all viscuSf so to express it.
Life, feeble in its character, seems, by the conservative law of
nature, to concentrate all its forces in the viscera, as the essentials
for its maintenance; and these forces are to be found in the blood.
Yet this same congestion of blood about the stomach renders the
formation of that fluid by the stomach an imperfect process ; and
a badly elaborated and poor blood always circulates in persons
of the ganglionic constitution, in which we detect another reason
for the want of re-active energy, the poor bloou depositing poor
solids — nervous solid among the rest.

When, therefore, in such a constitution acute disease invades a
part, the viscera are in the best possible state to render it perilous;
and if the immediate peril be overcome, to Tender it chronic, for
there is not sufficient vigor to produce a complete crisis of the
acute malady. Hence colds that involve the stomach — influenza
colds — and that hang about for weeks ; hence cough for months,
after inflammation of the air tubes of the . lungs ; rheumatism,
that vanishes partially with warmth and dryness, to return vigor-
ously with cold and damp ; erysipelas, that creeps about the skin,
but never totally disappears, and so forth. In aH which, mean-
time, we behold none of the slow inflammation of the bones, of
the glands, of the brain, of the tissue of the lungs, which are so
characteristic of the scrofulous diathesis, and constitute respective-
ly hip'joini disease and white swelling^ goitre, and swelled external
glands of the neck, water on the brain and insanity, and tuberctdar
consumption. Neither on the score of nervous sensations, nor
tendency of diseased action, can this constitution be deemed scro-
fulous. Moreover, it is most commonly acquired, not inherited ;
acquired by long-continued abuse of the nervous system, either
m the way of excessive mental sensations or excessive physical
SJcbaustion. And I call it not a disease itself, becausey to all

TERKnfATIONS OF CHXaNIC DISEASX. W

ifipeanuices, the subject of it is well, and is only in an apt statd
to receive disease.

The other constitution which predisposes to chronic disease is
the scrofidous* All medical writers have remarked the low de*^
gree of inflammatory action that obtains in persons of that con-
stitution, even when, from the mode of coming on, and from the
symptoms, it is called acute. Sub-acute would generally be the
more precise term to designate the morbid action. This is due
to the fact, that the innate power of the nutritive nerves and ca-
pillary bfood- vessels is low ; their condition is that of feebleness
and great irritability ; and the exhaustion following on the excite-
ment pf a morbid cause is consequently sudden and extreme ;
such, in short, as constitutes chronic exhaustion. Moreover, the
rallying power of those nerves and vessels is small ; and hence
it is that chronic disease is not only more readily established, but
is more slowly cured, in individuals of the scrofulous disposi-
tion ;* yet* although the inflammatory action accompanying it be
so low and slow, it is on that very account the more destructive,
the vitality of the part being more utterly lost. Thus, in chronic
abscess of the lungs (pulmonary c(msumpiion)y of the bones of the
loins (lumbar abscess), of the bones of the knee-joints (white
swel&ng), the destruction is so extensive as, in the vast majority
of cases, to carry off" the patient ; and these are all instances of
chronic disease occurring in persons of the scrofulous diathesis.
I shall enter more upon this subject in a future chapter. It suf-
fices here to indicate the disposition in question as a strong pre-
disposing cause of chronic disease.

All constitutions, likewise, that are dilapidated by previous
disorders, especially by typhus fever, scarlet fever, the various
forms of remittent and intermittent fevers, such as the yellow
fever of the West Indies, the jungle fever of the East Indies, and
ihe fen fevers of Europe, and by influenza and sypMHs, are much-
iiredisposed to take on the chronic form of disease. Referring to

• The difficulty of removing scrofulous inflammatory action is testified
by all writers on the subject : by Gibbs, Quincy, Morley, White, Hex-
NXK6, Li/>YD, Gooi>i<AX», Ci.ARKE» and others among ourselves ; by Hxrrs-
LAiro and Vering among the Germans ; and by Bordeu, Faure, Char«
METTON, Majault, Goursaud, aod BAUDEI.OCQ17S among the French.
Celsus says of scrofulous inflammations, ** praeipue medicos fbtigoM

36 THE CAVSS8, PKOORBSS, AN9

the rationale of that form, the reason of this will be sufficwBd]f
obvious.

Long contiiiued exertion of the intellectuar faculties — painful
tension of and pressure upon the affections—excessive use of tho
animal propensities, — ^these, by wasting the nervous energy,
impair that organic power, the exhaustion of which is the essen-
tial of chronic disorder, and may therefore be regarded as pre*
disposing causes of such disorder.

For a like reason, all losses of blood, or of some of its consti-
tuents, as in excessive secretions of mucus, urine, &c., tend to
the passage of acute into chronic disease. Hence it is that
hleeding with the lancet is such a fertile cause of this. The large
quantity of blood suddenly withdrawn from the body has invaria-
bly the effect of sending the greater part of what remains to the
internal parts — ^to the viscera. Innumerable facts and experi-
ments show this to be the case ; and when we consider that there
is the centre of organic life, we shall not wonder that the myste-
rious instinct of nature should send the nutritive liquid, the blood,
where it is most required to prevent the extinction of that life.
Now, it so happens that these bloodlettings are usually practised
for some acute inflammation of the viscera, and they certainly
sometimes answer the aim of reducing it. What takes place,
though, subsequently? On one hand, the whole body being
deprived of a mass of its blood, there is a rush of that liquid
towards the very viscera that were inflamed, and this the more,
the more the blood is drawn. On the other hand, the visceral
organic nerves being deprived, like the rest of the body, of a
quantity of nutritive liquid, lose also a quantity of that energy
which they derive, also like the rest of the body, from being
nourished by the blood. Thus, there are two reasons why the
previous acute inflammation should pass into the chronic, — 1st,
The nerves and blood-vessels have lost their contractile power —
that power which was to enable them to rid themselves of the
blood that oppressed them ; and 2d, The quantity of blood in the
oppressed part still remains sufficient to perpetuate the oppression.
To these may be added the fact, that the blood which remains in
the body is vitally affected by the withdrawal of its :former por-
tion. The blood itself is a living fluid, has an independent exist-
ence, and the shock to it is as the loss of a limb to the body ;
oesides which, the abstraction of a quantity of the red globules
m not very soon compensated by digestion of food ; on the con

TEXMINATIQNS OP CHKONIC D18BASS. 37

tmry, h is a very slow process, this restoration of the red glo^
bules; — ^men who have undergone large bleedings have been
fimnd, when bled so long as three years afterwards, to have not
yet recovered them, so watery, poor, and devoid of clot was the
blood taken. Such a state of the nutritive liquid is not likely to
improve the organic energy — ^that is, to resist and throw off cbro»
. nic disease.

Were I to detail the instances that have come be£>re me at
Malvern, wherein a series of nervous and other symptoms have
dated through years from, in some cases, a single large bleeding,
the recital would appal many who look upon that operation as
very simple and very innocent, because very commonly prac*
tised* I have seen persons afflicted with inveterate mdigestien
and hffpochondrioM ever since bleeding for acute inflammation
of the stomach. The most hopeless case of nervousness I ever
met with was that of a youth who, in the outsetting of small- pox,
was largely Hed for the headache wliich accompanies that stage
of the disorder. The result was a loss of power to the system,
which disabled it from the free evolution of the disorder. Stimu-
lants were given in large quantities to prevent death. His youth
aided them, and he got through it ; but between the bleeding and
the stimulants which it necessitated, the patient is an incurable
neuropathic. The repeated bleedings in acute inflammation of
the lungs prove a most fruitful cause of chronic disease in those
organs, and even of tubercular deposit and pulmonary 4ionsump'
Hon. I have seen instances of both in the persons of patients
seeking relief from the water treatment. I have here seen also two
cases of dropsy of the chest after acute pleurisy, which had been
treated by large and repeated bleedings. The non-professional
reader should understand that dropsy of the chest is the chronic
inflammation of the pleura, and that thus we have another in-
stance of the passage of the acute into that form of disease attri-
butable to bleeding. But a more ordinary result still of bleeding
is general dropsy. Here the loss of the nutritive liquid so debili-
tates the blood-vessels, that they are unable to carry on the vital
chemistry in a healthy manner; and the watery parts of the
blood are separated in large quantities instead of the peculiar
tissoes of the different parts of the body. Some years ago, when
bleeding was more commonly practised than at present in ordi-
nary fevers, the occurrence of dropsical effusion in some of the
oatitiev.of th« body, or under the skin, was a most frequent con«

38 THK CAITSES, PROGRESS, AND

comitant of the convalescence from them. And this convales*
cence itself, what is it but a chronic following on the acute fever)
Of this more anon. Meantime, I repeat that, in the vast numbel
of chronic cases presented for treatment at Malvern, blood-letting
is clearly traceable as a cause. The patients tell me that ** they
have never been well since ;'* that " they were, going on very
well until they were bled," that " everything tells upon them
more severely since they are bled," and so forth — facts which speak
trumpet-mouthed as to the destructive agency of that too com-
monly used operation of bloodletting.

As if, however, this were not enough, the system of drug medL
cation^ so much relied upon in acute malady, comes to aid in
perpetuating it in the chronic shape. In fact, it is almost impos-
sible to conceive of an acute disease being cured by these double
means of phlebotomy and physic. The very legs of the frame,
so to speak, are cut from under it ; the very forces by which it is
to throw off the malady of the vitals upon some tess important
part, are taken away with the blood that flows, and paralysed by
the confused stimulation of various drugs. On this subject I
cannot do better than repeat what I have said in my *< Simple
Treatment of Disease ;" and let it be remarked that what follows
was written before I had become acquainted with the water treat-
ment, and must therefore be taken as my conviction at a time
when I was still classed among the practitioners of drug niedi-
cation.

" A physician acting on this treatment, in a case of simple fever,
would, in the first place, attempt * to cut it short,' as it is termed,
by a copious bleeding from the arm, and, immediately on the
limb being bound up, by an emetic. If this does not dispose of
the fever in a few hours, he administers repeated doses of calo-
mel, opium, and antimonial powder, with some powerful cathart-,
tics, in which he persists, in the expectation of causing healthy
evacuations. An the meanwhile, time is found for the adminis-
tration of a mixture of sudorifics and diuretics. So things go on
for six or seven days, the patient being told, as regards diet, that
he can take * any little thing that he fancies,' — but not beef-steak
or mutton-chop. At length the brain gives symptoms of being
afTected-^elirium supervenes. Then begins the array of revul-
sives on the external surface ; the head is shaved, ice is applied
at the back and front, and a blister on the top of it. The deli«
rium pfu»ing from the furious to the muttering kind, the toogue.

TBRXINATIOlfS OT CHBONIC DISXASB. Si

beeoming dry and brown, the limbs utterly powerlesSy^in Bhorti
all the signs of a typhoid state appearing, the stomach is once more
tried with wine and other stimulants, the feet are blistered, and
exhausted nature sinks ; or if, in spite of all, the jaws of death
are escaped, the body, drained of its blood, worn out after the
enormous stimulation, and utterly thrown out of the rhythm of
its sympathies and functions, drags through a prolonged conva^
lescence, with a tardy recruiting of the quantity, and still more
slow restoration of the quality, of the vital fluid that it had lost,
and of the nervous energy it had previously possessed. Even in
this state, a little revulsion is essayed in the form of bitter tonics,
carminatives, anti-spasmodics, &c., and sometimes a relapse into
another species of fever called nervous, is thereby brought about."*

Further on in the same work this subject has a greater develop*
ment ; in the course of which the following remarks are apposite
to the present argument : —

<< Persons called, or calling themselves, bilious, those of confined
bowels, accompanied with heat of mouth, tainted breath, frequent,
and to them inexplicable, headaches, having cold* feet, occasional
lassitude of limbs, and almost constant irresolution of mind, al-
though constitutionally otherwise endowed ; who go about their
business and into society, but have not much pleasure in either ;— *
these will be found to carry about them the germs of that visceral
condition which,' upon some accidental cause, breaks out in acute
indigestion, bilious, rheumatic, or even typhoid fever ; but which,
by timely rest of the digestive organs and those of animal life,
without the interference of medicine, might have been easily
eradicated. Instead of this, they drug themselves — are relieved ;
again feel ill — repeat the dose ; eating, drinking, dancing, and
bargaining, meantime, with all possible avidity, until outraged
Nature forces them to halt, by a complete paroxysm of sickness,
and thus saves those who would not save themselves.

" Observations such as these are the more appropriate in this
place, as 1 am about to speak of the treatment of several kinds
of fever, which are almost invariably preceded by the sub-febrile
state alluded to. Were non-professional persons better acquainted
with this fact, and did they, knowing its occurrence in themselves,
abandon the treatment to Nature instead of trusting to a worn
out prescription, they would avoid attacks for which they would

* L(ic. cittp. G5.

40 THS CAUSE9, PX0GKJI88, AND

gladly compound by a few days' withdrawal from all buainett
and all pleasure. Capable of moving about, yet doing so with
early fatigue, they imagine their complaint to be weakness, and
stimulate the digestive organs to overcome it ; or, coming nearer
to the truth, they suppose themselves bilious, and take physic and
devour bacon at breakfast. At length, on a certain day, after a
mental shock, great exertion, a cold air in a passage or through a
window, wet feet, some change of clothing, or a crowning excess
of diet, shiverings seize the patient ; and, according to constitu-
tional and accidental circumstances, the symptomatic array of
rheumatic, inflammatory, or typhoid fever is in a few hours estsu
blished. That such is the process — ^that visceral derangement
precedes by some the feverish outbreaking — ^I have verified in
hundreds of instances : and that the fever is fully developed when
the irritation, in whatever viscus it may be, has become suffi-
ciently intense to link together more or fewer organs in its mor-
bid sympathies, those of animal life included, is, in my belief,
sufficiently clear. It is not that the exciting causes-cold, for
instance — has driven the blood inwards upon the viscera, as is
commonly asserted ; but the latter have for some time previously
maintained a morbid sympathy with the surface, which rendered
it unable to re-act upon the cause in question as it would do in
the health of the internal parts. Upon these, then, as the strong,
holds of life, the office of reaction devolves : and hence fever has
been not unaptly denominated an eflbrt of Nature to bring a
morbid process to a crisis ; a crisis that varies in period ai<d
character with the vital energy of the patient, with the length of
time during which he has neglected or exasperated the previous
symptomatic warnings, and last, not least, with the amount of in-
terference with the morbid viscera before and afler the full de-
velopment of the fever.

" With this view of the febrile condition (and it is one for the
reasonableness of which eminent names in medicine might be
cited), the propriety of violent revulsion practised on the organs of
vegetative life is, at least, very problematical. These last are
laboring to effect relief for themselves by transferring the irrita-
tive action to one of the great emunctories, the lower bowel, the
kidneys, or the skin, — ^to the latter, in the great majority of cases.
How is this to be done, whilst means are taken to retain the irrita-
tive action in themselves? whilst calomel and antimony are
exciting the stomachy and senna, scammony, and other strong

» TERMINATIONS OF CHRONIC DISEASE. 41

puj^tives, are drawing blood to the whole canal to supply the
enormous excretions they produce ? whilst, as if to force all the
emunctories together, a conflict of diuretics and sudorifics comes
to aid the mercurials and purgatives in making < confusion worse
confounded' in the already oppressed and irritated internal organs ^
It is such treatment as this ttiat justifies the jest passed on medicine
in the definition of a physician as one who, armed with certain
weapons, lays about him in all directions, with at least an equal
chance of extinguishing the patient as the disease. For, although
the patient may recover, notwithstanding the tumult into which
the viscera have been thrown, the chance is considerably in favor
of this tumult being extended to the great viscus of animal life,
the brain, whose function is first deteriorated and then destroyed.
" But in the event of recovery, what do we behold ? A body
drained of its blood (for copious bleeding is with many the first
step in treatment), exhausted in its nervouis energies, with viscera
that have been subjected to every phase of irritative action, and
now in the extremity of consequent coll apse,^-d ragging its
enfeebled organs through a long convalescence, one function and
then another stumbling on the road, and falling back into the old
disorder, without the rhythm, the combination of all of them
moving onwards towards health, which should mark the restora.
tion of calm to the system. The convalescence itself is a veritable
disease, a train of disorders. There is the nightly sweating, indica-
tive of the terrible exhaustion of the frame, for which acids are
given; the inappetized stomach, for which tonics are ordered:
these, again, aid in constipating the bowels, already deficient in
activity afler the vehement efforts of secretion to which they have
been stimulated : there is the flying spasm of the abdomen, now
in the stomach and then in the lower bowel, for which carmina-
tives are administered. Then, as regards animal life, there is
the sleepless brain nightly stupified with narcotics ; there is the
tremor of limb and lip, that oflen continues for months: the
hysterical condition of mind : the tendency to fainting in even a
moderate degree of warmth : the nervous headache, that fre>
quently from this date takes up its abode in the system for the
remainder of life. Withal, there is a general sensitiveness to
causes of disease, that persists for a considerable time, and,
coupled with the active medication still in progress, enhances the
risk of fresh febrile attacks before the body shall have acquired
the stamina to re-act against them.

Ifi2 <^ THB CAUSES, PR0aB£8S, AND «

<^Si}eh 18 the sketchy history of fever treated according to the
method which makes the internal parts the subjects of revulsiTo
«ction ; a method which increases the dangerous risks during the
malady, causes the infliction of prolonged convalescence, and by
this last fact exposes the frame disadvantageously to renewal
disorder. And all these results flow from a neglect of the maxim,
that death comes only by the viscera, and that too much care can-
not therefore be observed in the treatment of th^m, when they are
the seats of disorder."*

For the truth of these observations I am more pledged than ever ;
now, that from the vast number of chronic cases that have come
before me since they were written, I have been more extensively
and more intimately made acquainted with the long persistent
results of the practice they describe ; now, too, that in a few
instances of my own practice, I have had opportunity of observing
the far, far more favorable condition of patients who have recovered
from fever by the means of the water cure. It is idle to call thb
prejudice: on the one hand, the patients tell their own tale, and
come to the- same conclusion ; on the other hand, it is reasonable
that I should assume to use the external senses, and that internal
sense, which appreciates inevitable deductions, in common with
the rest of the medical world. And doing so, my conviction is,
that the above, the ordinary mode of treating fever, is pernicious
in the extreme, puts in peril the life of the patient, and, if he dies
not, burdens that life with the miseries of some chronic disorder.
Again, it is idle to blame individuals for a system — a system in
long and common usage ; they work with the instruments they
possess, and conscientiously believe to be good for the purpose.
At the same time, their belief and praise neither render the system
good, nor prevent the staring fact, oft repeated by patients with
chronic disease, that such disease has been their lot since the
treatment of acute fever, three, four, or more years ago.

But if the ordinary medicinal plan be active in forming chronic
out of acute disease, it is more potent still in maintaining the
former. The emergencies of acute disorder, where the first
thought is to save life, may aflford some palliation of the rough
handling of the delicate viscera in its course (though I maintain
that the physician should have an eye to the consequences in life,
as well as to the chances of death); but, in my opinion, no

* Loc. cit, p. 112, et seq.

TBBMINATtONB OF CBMOmC DIS£ASB. W

excuse presents itself for a continuance of the same vigorous
medioation in the chronic form, where the question of life or death
is not imminent. The most superficial obeerration must show
that cure never takes place from such medication, and that exas*
peration of the malady is the far more frequent result ; while
some reasoning on the intimate condition of the parts chronically
diseased, leads to the conclusion that cure canuat take place, and
that exasperation mtut.

For let us look into a chronic inflammation of the stomach and
liver, commonly called indigestion and MHaumess. We have in
these a very exhausted and irritable state of the capillary blood*
vessels of the mucous membrane which lines the stomach, and by
extension of surface, the ducts of the liver. - The ordinary
treatment by drugs consists in the administration of mercurial
medicines to stimulate and alter the secretion of bile from the
liver ; of tonics, such as bitter vegetables, iron, bismuth, sul-
phuric acid, blue and white vitriol, lunar caustic, arsenic, dsc,
to procure a fictitious appetite ; of alkalies and opiates, to obviate
heart-burn and other pains ; of various spirituous and peppery
articles, such as lavender drops, tinctures of cinnamon and carda-
mom, sal volatile, cayenne pepper, &c., to remedy the flatulence
and spasm of the stomach ; and of the long list of puj^atives, to
overcome the constipation which is the usual attendant of this
dyspepsia. In each twenty. four hours the highly irritable and
wearied blood-vessels are called upon to respond to the stimulation
of one, at least, of each of the above classes of remedies, and from
what has been shown in former chapters, the result of this is plain
enough. The blood-vessels, stimulated again and again, fall into
more and more hopeless exhaustion, and become more and more
irritable. The blood they contain increases in quantity and de-
teriorates in quality, which deterioration causes the secretion of
more bad bile and more acid and acrid juices than ever, and
finally leads to the deposit of unnatural solid matters, cancerous,
lardaceous, &c., constituting a true organic and incurdble disease.
But besides this, and meanwhile, the bad quality of the bile and
stomach juices is causing a bad digestion of food ; bad blood is
formed, and the whole body languishes in its functions, from be-
ing nourished by a badly elaborated blood. And thus the treat-
ment proceeds, until the medicines of the various classes being
exhausted, and the patient worse, nothing remains but to go tf
the sea-side, to a farm-house, or to travel, during the operation of

44 TBS CA08BS, PBOGEBSS, AMfi

which healthful and natural stimulants some improvem^it takes
place — ^the viscera have had the chance of rest, and have used it
for their own preservation.

It is not my intention to expatiate on this subject, else I could
show by not a few illustrations how this complex medication,
this polypharmacy, necessitates the employment of each of
the medicines comprehended in it, to obviate the efiects of
another ; how the effects of the mercurials have to be combated
by the opiates ; how these, again, produce a necessity for the
purgatives ; these, for the remedies for flatulence ; and these,
tigain, producing heart-bum, call for alkalies and opiates. Begin
where we will, the circle must be traced : the explanation of
which is, that as they all unnaturally stimulate the blood-vess^
and nerves of the part, these fall, after each stimulation, into
another degree of exhaustion, which induces fresh symptoms to
be met by fresh remedies. This alone, this necessity for heap-
ing one remedy on the back of another, might suggest that the
whole plan is radically wrong, and that the root of the malady,
the essential character of It, is not attacked ; else why does an
evil follow each remedy, to be corrected by another remedy 1 It
looks like a combat between the medicines, for which the dis-
eased stomach is the arena, rather than between the disease and .
its curative means.

The truth is, that it is physiologically impossible to adapt such
coarse means to the infinitely minute shades of irritation which
constitute the essence of internal chronic disorder. Unless you
can find medicines of such character and in such amount, as,
when applied, to give to the blood-vessels the exact degree of con-
tractile power that shall rid them of the blood which oppresses
them, and no more, you either do nothing or mischief. If the
stimulation you thus apply be too small to give the vessels the
power in question, not even temporary relief ensues. If it be
excessive, which is usually the case, greater exhaustion than be-
fore follows, and matters are worse than before. The conse-
quence is, at the best, a hap-hazard practice, and at the worst a
mischievous practice — the latter, alas ! being the rule ; for how
is it possible to hit the precise stimulus ?*

• «• I can do it," says the homoeopathist, «* with my specifics and my in-
finitesimal doses." And certainly the homosopathist comes nearer it far than
tiie ordinary practitioner. His is a much more rational plan, which, look-

TEBHnVATIOllS OF CHBONIC BiatBASK. 41^

Sufih is the mode in which the ordinary medicinal treatmenl
beeomee a cause, and maintainer and aggravator of chronic dis-
ease in the internal central organsf of life — ^whence the mischief
is propagated to any other organs of the hody. And this is the
eaae when disorder is originally in some external part. Thos
some violence is applied to an arm or foot, the irritation of which,
conveyed to the internal organs, produces disorder there, and
feverishness. To these organs, thus sympathetically excited,
irritating i^perients^ dec., are applied, as is usual in fever, the con-
sequence of which is the establishment in them of an irritation
which radiates again towards the diseased limb, where a similar
establishment is made. The limb proving obstinate, the pain,
heat, swelling, &c., contmuing, notwithstanding the cooling purga-

ing to the specific irritabilities of different tissues, strives to discover the
particular stimulus adapted to each tissue, and, more than that, to the
numerous grades of irritation whieh each tissue is capable of exhibiting.
This is a matter of sheer experiment and experience ; and, accordingly, we
find in the homoeopathist infinitely more nicety and accuracy of observation
than is necessary to the allopathist in his practice, where specific effects
are sought for by a strong revulsive operation on the stomach alone ; that
is to say, the disease, however distant, is concentrated in the stomach
during the operation of the medicine. Besides their having a specific
effect, infinitesimal doses of the medicine used by homoeopathists are, in
theory, much more likely to alfect the minute and highly sensitive ca-
pillaries than the coarse and overwhelming doses of the allopathist: and
this I have ascertained in practice to be the case in very many instances.
It is well and wise to observe and investigate these things before laughing
at them : the homoeopathic dose, the three-thousandth part of a drop or
grain, if you will, i» more effectual than the allopathic ten or twelve grains,
however laughable it may appear. As for the maxim of the homceopathist,
that " like cures like," which has also been ridiculed, it was put in prac-
tice by the allopathist without his knowing it, until the homceopathist told
him of it ; since when it has been left in peace.

Still, in homoBopathy as in allopathy, though not equally in both, the ob-
jection applies that the body is not allowed to throw off its own disease ;
without which cure is unattainable. There is still the forced change of
action in the diseased part, on the permanency of which reliance cannot be
placed. There is still also the employment of the stomach for all medicines,
and therefore its fictitious stimulation by all. And with these objections,
although I might be induced to try to subdue a passing, but troublesome
iymptom, I could not trust to remove the essential nature of a chronic
malady by homoeopathic means. But I speak of the whole, subject with dif-
fidence, my experience being as yet limited. Not so with allopathy, tha
insuflSciency of which has been proved to me by sixteen years' practioe.
How far might tha homasopathic come in aid of the water troatment ?

46 THE CAUnS, PBOOIUBM, AJMO

tives administered, a course of mercury is the ooaimoii reaoorce
—why, it is not yery clearly ascertained*— to which opium is
sometimes added, to produce a sudorific effect. By this, both in*
tecnal and external irritation become more decidedly chronic ; and
this is further aided by courses of iodine, iron, arsenic, ^., in
succession, all given with the view of, somehow or other^ ridding
the limb of the congested blood it contains : it apparently never
occurring to the administrator that, by producing chronic disease
within, he is taking the best means of perpetuating it without. I
have known this go on until the patient was fairly told that,
everything having been tried in vain, there only remained ampu-
tation of the leg — an alternative to whiqh he preferred the water
treatment, assuredly fatal as it had been represented to him. He
walked without crutches in six .weeks !

It is by such a process as this that rheumatism and He of the
limbs are maintained by the very means intended for their relie^
— ^that skin diseases are inveterated, and old ulcerations kept open.
You establish chronic irritation at the centre, and thereby keep it
up at the periphery. The rule is invariable.

Stimulating diet acts in the same manner as a cause of chronic
disorder. Yet, well ascertained as this is, it is at once painful
and wonderful to behold the laxity of practice regarding it, both
in the medicinal and the water treatment. In the former, this
want of stringency is attributable to the facility with which the
immediate results of indigestion are avoided by medicines, no
thought being given to the ultimate and lasting effects of both.
This renders both patient and practitioner less anxious on this all*
important point. In the water treatment, as it is very often prac-
tised, the same remark is to be. made ; but I shall have to renew
the subject in another part of this work.

As the brain and spinal cord represent an immense mass of
blood-vessels and ganglionic nerves, and are thereby kept in a
state of close organic sympathy with the central portions of the
organic nerves, and thence with the rest of the body, it might be
expected that irritation of those organs would tend powerfully to
cause and maintain chronic disorder ; and constant experience
shows such to be the case. Intellectual labor and moral anxiety
each or conjointly keep up the derangement of other parts ; the
latter, perhaps, doing it more intensely than the former. To

*• Pluck from the memory a rooted rorrow.
Raze oat the written troaUee of the bnan."

TKBMmitlOXS 09 CQEOniC DiaSASS. 4T

is an tmaviiiHng endeavor when the sympathies of the digestive
organs have been involved ; for th^e, in return, maintain the
irritation of the brain, and the unlucky patient is the prey of two
chronic mischiefs, which few can long withstand. Cause and
efieot become confused, and the practitioner is puzzled where to
begin. It appears to me, that if the core of life in the chest and
abdomen can be put into a condition so as more steadily to resist
impressions from the brain, the latter receiving fewer irritations
from that point, the mind will be thereby better enabled to struggle
with its load, and throw it off. In fact, unless the mental distress
prey upon the digestive organs, it is certain not to last : the pro-
verb, that " a hard heart and good digestion go together," is based
in truth : he who knows not suffering is the least likely to pity it
in others or be anxious for any one. Whilst, therefore, it is of
course advisable to remove the moral cause as. far as may be, it
is, at least, quite as necessary to avoid additional irritation of the
abdominal organs, the stomach, d&c; and looking to this, we mus^
observe the folly of giving stimulating diet and medicine^ to dis-
sipate moral clouds : they can only thicken the gloom of the mind
in proportion as they complicate and inveterate the physical dis-
order. Wherever the mischief begin, therefore, I should, above
all, have a care of the viscera and ganglions.

Care, anxiety, and grief, more especially, give rise to chronic
nervous dyspepsia, diseased heart, pulmonary consumption, and
dropsy, the rationale of which is sufficiently obvious from what
has preceded. They also originate, by the medium of the
stomach, certain forms of skin disease, such as scaly-tetter
(psoriasis), and dandriff (pityriasis), which diminish and exaspe«
rate with the mental condition.

Intellectual labor, if sedentary and silent, produces rather
chronic mucous than nervous dyspepsia, obstruction of the Uvery
and, as a consequence of that, piles. But it generally leaves the
viscera of the chest, the heart and lungs, untouched. The pre-
ceding paragraphs would lead us to expect, what really happens^
that, if to such labor, any of the passions, or care, be added, the
results to the entire viscera of the chest and abdomen would be
most destructive. The experience of medical men oould tell of
many obscure yet useful laborers in literature whom this double
load broke down and pressed into an early grave, demolishing one
function afler another — ^the exhausted brain sometimes giving
way the first; and similar histories of authors more << bruited in

48 THE CAirSBS, FK0GRB8S, AND

men's ears '^ are familiar to all of us. And whilst we maj de*
plore their fate, we must not forget to recall in how many of them the
glorious gift of Thought was misused in the practice of sins against
the bodily organization, of intemperance, which multiplied and ag*
gravated the ills which Providence had thought fit to try them
with ; for the same Providence ordains that man, to whom a lofty
brain has been given to control his viscera, shall pay a heavy
penalty when he employs it in committing outrages on them : and
these the glutton, the drunkard, and the drug-eater do daily
commit..

If, however, labor, of the intellect be accompanied with much
employment of the lungs, as in parliamentary and forensic debate,
or hustings' eloquence, the consequences, in the shape of nervous
and mucous disorder of .the digestive organs, are neither so rapid
nor so intense : and this because the unute that attends the exer-
cise of the lungs calls upon the digestive organs for fresh supplies,
thereby quickens their function, and thus prevents that congestion
of blood in them which constitutes their own chronic disorder, and
maintains that of the brain or of any other part.

Such are the causes which tend to the establishment of chronic
disease in any tissue or organ of the body. They all become
causes by inducing or implying a feebleness and irritation of some
portion of the centre of the organic system of nerves, and
especially of that which corresponds to the starting point of the
body's nutrition, the stomach and liver ; and it is the vitiation of
the nutritive energy at its source and core which keeps up a
similar vitiation of nutrition, called chronic disorder, in distaht
parts of the frame. Without it there is no chronic disease : with
it, such disease is inevitable and incurable.

Of the progress and terminations of chronic disease in general
much need not be said in this portion of the work, as I shall have
to speak of those which mark individual diseases, in another por.
tion. Dividing the latter into internal and external, a few obser-
vations may be made on each group.

Chronic disease, which is confined to some internal part, is
usually the most destructive. It has no counteracting irritation
on the external ^surface, but concentrates the whole morbid action
within. Pvlmonary consumptixm is an instance of this ; so is
neuralgia of the stomach, a form of nervous dyspepsia ; ulceration
of the bowels ; and that irritation of the small bowels which
causes atrophy : in none of which is there any external eruption

TMBMIXATlOnS OF CHROMIC DI81ASB. 49

or pain to diminish the destructive work going on within. Dis-
eases of this kind, therefore, have a certain and rapid progress
and termination. Failure of the digestive energy is the cause
of death in all. In pulmonary consumption, for instance, the
patient suffocates for want of muscular energy to expectorate,
which feebleness is due to deficient nutrition of the nerves and
muscles that are used in expectoration, whilst the deficiency in
point is the result of mal-digestion in a stomach in a state of
chronic irritation. Had the stomach been in sound digesting
order, the patient would have lived on, notwithstanding the drain
by expectoration. In the other instances quoted, the same failure
of nutrition is the reason of the downwaid pn^ress and extinc-
tion of the individual.

But, although in such internal chroi^c diseases there be no
external counteraction of skin or other disease, an attempt is
frequently made, in the course of them, by the disordered organs,
to throw a portion of their irritative action on the external parts,
or upon those parts less essential to life, such as the lower bowel.
Under this head come the hectic fever, that so oflen accompanies
chronic disease of important organs; and the sweatings and
diarrhoea. Febrile attacks, also, of a more ordinary kind, the
simple inflammatory and bilious fevers, mark periods of internal
malady when the vital organs strive to cast their mischief from
them ; and more or less successfully, too, if they be not meddled
with by officious medication ; in which case the chronic malady
is re-concentrated internally with augmented fixity. Patients
are always better afler such an outbreak: it is more or less
critical ; but the condition of this is, that it be the result of the
natural efforts of the diseased part, not by forced means of stimu-
lation. Sulphate of iron will tnnd up the stomach in nervous
dyspepsia to the feverish effort ; hut woe to the patient who flatters
himself that it is critical of his dyspepsia ! Like tfll forced
crises, it inveterates the mischief.

These feverish uprisings in the progress of internal chronic
malady are coincident with a lighting up of an acute condition
in the diseased organ. The symptoms are all those of that con-
dition, and the usual chronic symptoms are wanting. The suf-
ferer from chronic dyspepsia, who had a good appetite, loses it in
this acute stage, becomes thirsty, having previously had no
thirst ; — exhibits, in short, all the differences between acute and
chronic indigestion^ The same takes place in long-standing in-
4

50 THE CAUSES, PROGRESS, AN]>

flammation of the air-tubes of the lungs, the patient now and
then being threatened with suffocation from acute inflammation
extending lower down the tubes towards the spongy substance of
those organs. The internal condition which is essential to goui
and tic doulouretix is likewise subject to these exacerbations, ac-
companied, of course, with increase of the gouty or neuralgic
pains.

It is by no means easy to explain these explosions of acute
disorder in the progress of chronic disease : the more, as they
very frequently occur without any detectable cause whatever.
To me they appear as so many efforts of the vital organs to re-
cover themselves by bringing about some critical termination,
and re-establishing the balance of circulation and nervous power,
for such is not unfreqlently the result ; and where it is not,
acme new, and, mostly, improved feature is given to the chronic
malady. Further than this it is mere conjecture to speak re-
garding the cause of these acute attacks. They evidence the
restorative power of the body ; and as they do not occur when
the exciting causes of the disease are continued in full operation,
it may be said that such power accumulates for healthful pur-
poses whenever those causes cease, even in degree, to operate in
exhausting it. The dyspeptic patient who persists in the use of
irritating food gives no pause for this accumulation : he is wast-
ing the power as fast as it can be generated ; and a time comes
when it cannot be generated, and then comes organic disease,
wasting, and death ; whilst if the food be changed in quality and
diminished in quantity, the restorative effort is sure to be made,
sooner or later, with greater or less vigor and effect. And ac-
cording to the degree of these is the fact of a broken or unbroken
constitiUion : in the one, the effort being feeble and ineffectual ;
in the other, powerful, and nifliking some step forward. In this
view these uprisings of the constitution under chronic diseeuse are
important to be observed, affording to the physician a criterion
of probable success or otherwise, from the acuteness or atony-
displayed by the body ; and in speaking of the modus operandi
of the water treatment, I shall have occasion to call attention to
them as almost invariable attendants of its course.

In a previous part of this volume I have shown that the nervr
ous system first involved in disease is the ganglionic, or that which
has its central portions in the abdomen and chest. In very acute
diseases — such as are almost sure to prove fatal'-^the implicatioB

TEKMIHATIONS OF CHBONIC DISBASB. 51

of the ammdl nervous system, the hrain, and spinal cord, is rapid ;
and complete proetration of will, delirium, more or less paralysis,
convulsion, spasm, or stupor, attending the latter stages of the
disease. In chronic disease, the same implication usually takes
place, sooner or later. But here the phenomena are more varied,
because they have a less violent and more varied cause, are pro-
duced more slowly, and can be observed more deliberately ;
independent of all which they are different from those which ex-
hibit the implication of the brain in acute disease. Morbid ana>
tomy demonstrates that a vast amount of chronic disease of the
oi^ans of the abdomen and chest is compatible with total absence
of disordered phenomena of the brain. Men have died of stomach
disorders that, from their state, as shown after death, must have
existed for years, and yet were never fel^by the brain, nor even
produced in it an ache, giddiness, confusion, nor any other mor-
bid sign. In such persons there can be no doubt that a congeni-
tal deficiency of nervous communication between the viscera of
the abdomen and chest and the brain obtains, or that a want of
vivid nutrition obtains in the latter. But this is the exception.
The rule Is that the morbid irritations of the organic nerves are
transmitted io the brain and spinal cord, becoming more intense
in character as the chronic malady inveterates. The variety of
the phenomena is great, and depends on the ganglionic viscus
affected, and on the numerous gradations of that affection. Thus
one sort of stomach irritation generates that peculiar brain irrita-
tion which is accompanied with the mental symptoms of hypo-
chondriasis ; whilst another sort shall gradually induce apoplectic
fulness y another paralytic congestion of the brain. ^ chronic
irritation of the womb involves the brain, so as to cause the ca-
pricious storms of hysterical passion ; or the spinal cord, so as to
{NToduce hysterical palsy. These are the extremes of the scale,
below which we find simple headache of a nervous or * mucous
character, confusion of head, irregular vision, hearing, taste, or
smell; dreams, both sleeping and waking ; irritability of temper,
tuitchings of the Umbs, asthmatic breathing, irregular neuralgic
pains, &c., &c. All these and many more are symptoms of that
disordered nutrition of the brain and spinal cord which sooner or
later takes place in the progress of chronic disease of other parts.
I say " sooner or later" only with reference to the varied sus-
ceptibility of individuals, and the varied amount of original gan.
gliooiCt visceral disorder; the implication of the brain taking

62 V TH£ CAUSES, FROGaESS, AND

place more rapidly when that organ is highly susceptible than in
others, and vice versa. But as regards the actual period of such dis-
order, it only involves the brain after it has existed for some time, —
tiiat is, later rather than sooner. It would appear that the gan-
glionio mischief is confined, as regards symptoms, to its own sys-
tem of nerves for a certain time and up to a certain stage of irri-
tation. Arrived at that stage, it is sufficiently strong to elicit the
phenomena of the brain and spinal cord, mentioned in the last
paragraph ; and then nervous symptoms, as affections of the am*
mal nervous system are peculiarly called, are added to the pre-
vious ganglionic irritation. Doubtlessly, from the very onset of
the latteif^^morbid sympathies were sent up to the brain — it is im-
possible to suppose otherwise, in such a complicated and highly
organized frame as the human ; but these are not of sufficient
intensity to be shown in the form of symptoms. Once established,
however, they complicate the chronic malady, hasten its progress
towards organic disease, and multiply the obstacles to the success-
ful appliances of medical art.

Further, there is a gradation of nervous phenomena observable
in the progress of chronic disease. At first they are those which
indicate augmented circulation and nutrition of the brain matter,-^
euch as headache, disordered external senses, want of sleep, men-
tal irritability, hysterical sensations, &c. But as the mischief
increases, symptoms indicating oppressive circulation of blood in,
and diminished and vitiated nutrition of, the brain are observed, —
such as depression of spirits, unwillingness to move, hebetude of
mind, amounting sometimes to stupor, hypochondriacal brooding^
&c. : the rationale of all which may be given in a supposed case,
as thus : —

A person has a chronic, mucous indigestion — that is, a chronic
inflammation of the mucous membrane of the stomach. For
some time there are inappetence, fulness, constipation, thirst, &c.,
symptoms referable to and residing in the disordered viscera
themselves : after a time, and consequent on the continuance of
the causes, and, perhaps, the additional irritation of tonic and
purgative medicines, the mucous inflammation becomes so intense
and fixed as to invade and involve the nervous networks and
g€Uiglions that pervade the digestive viscera : nervous indigestion
is superadded to the simple inflammatory. Then begins the
series of symptoms which show the implication of the brain and
iq>inal cord — symptoms expressive of increased quantity of blood,

tERM: NATIONS OF CHRONIC DISEASE. 6S

in those great nervous centres. This increase goes on until the
pressure of hl.x)d upon the matter of those organs interferes with
its functional activity ; sensation, thought, and volition hecome
more and rnore obtuse and slow, until you may have total suspen-
sion of all of them in apoplectic stupor, or of sensation and voli-
tion in paralytic helplessness.

Such is the too frequent history of chronic visceral disease,
complicated with brain disorder. The confirmation of the view
just taken of the progress of the complication in question it
curiously enough exhibited by this fact, — viz., that in the firs!
stage of nervous complication all that goes on in the digestive
viscera, the irritation and weight of every meal, the rolling of
every volume of air in the bowels, and such like dyspeptic signs,
are accurately and acutely felt by the sensitive and morbidly
active brain, the patient complaining of them, and of\en dreading
to eat from fear of these consequences ; whilst in the second, or
oppressive stage of brain complication, these abdominal sensa-
tions are infinitely less complained of, the patient mostly asserting
that he has no stomach disorder, because he has no uneasy sensa-
tions after food, &c. In the former we have excessive activity,
in the latter deficient evolution, of brain power : in the former,
sufiicient blood in the brain to augmein its function ; in the latter,
sufficient to oppress it. And we shall find, further on, that in
retracing the steps to health, these two degrees of brain irritation
are retraced also.

There are several more circumstances in the progress of
chronic disease which might be mentioned, but which, as they
occur exclusively in individual maladies, are better postponed
until these last are treated of. Instances of these circumstances
are the variations of cough, and expectoration, in certain stages
of chronic lung disorder ; attacks of jaundice, and variations in
the bile in the excretions of the bowels and kidneys, in chronic
liver disease ; and the appearance or non-appearance of chalky
deposit, in the course of gout. Meantime, the phenomena com-
mon to all chronic diseases in their progress having been given,
I pass on to speak of the terminations to which they are liable.

These, the causes not being removed and irritation not avoided,
are inevitably fatal, if the seat of the chronic malady be in the
viscera alone. ^If there be skin disease — i, e., an external irrita-
tion, at once symptomatic of and counteracting to that internal
irritation which is the main disease — ^not life perhaps, but life'a

54 THE CAUSES, PROGBSSS, AND

comfort, is more or less destroyed, similar negligence or mal
practice as to causes being supposed.

The death of the body in such instances is induced—

1st. By obstacles to the nutrition of the body, the process of
waste, meanwhile, going on.

2d. By the passage of chronic disease into organic disease.

3d. By apoplectic congestion and functional stoppage of some
important organ.

4th. By effusion of fluids into different cavities, either with or
without ulceration of the viscera.

1. In many cases these two first causes of death are com-
bined, the organic disease being the obstacle to the body's con-
tinued nutrition. Thus cancer of the stomach, by causing the
incessant rejection of food, precludes the renovation of parts
which the process of absorption and waste is incessantly carry-
ing off. Organic disease of the mesenteric glands stops the pas-
sage of the chyle from the alimentary canal to the circulating
blood, and, by thus arresting the renovation of the latter, leads to
the death of the functions. Stricture of the gullet kills, likewise,
by stopping the supply of food. And there are a few more ex-
amples of the same kind.

But obstacles to the nutiltion of the body sufRcient to produce
its death exist in chronic disease without the intervention of or-
ganic disease. The failure of ganglionic nervous energy is
attended with failure of all appetite for food ; and not only that,
the same nervous exhaustion leaves the animal chemistry of the
stomach without due control, and secretions are poured out which
render the digestion of whatever aliment is taken bad, the subse-
quent blood-making imperfect, and the nutrition of the body,
therefore, imperfect also. Waste, meantime, proceeds, and the
individual perishes. This mode of death obtains in various forms
of dyspepsia, especially the nervous. Emaciation may go on to
a great extent before this termination, but not necessarily. If
the brain cease to be supplied with sufficient blood, of proper
quality, for its office, fainting may occur on some exertion of
mind or body ; the heart, imperfectly nourished and deprived of
its ganglionic power, may be unable to renew the circulation
of the brain : the animal being dies in consequence, and the or-
ganic being soon follows ; and this may happen Jong before the
patient reaches the point of atrophy, and it demonstrates the

TEEMINATIONS OF CHRONIC DISBASE. M

practical necessit} for rest of the animal nervous system in such
maladies.

Again, in chronic diseases of the small intestines, whence the
chyle is absorbed to be carried into the circulating mass of blood,
the inflamed and gorged condition of the mucous membrane upon
which the chyle ducts debouche, suffices to stop up their orifice*
and thus to prevent the recruiting of the blood by the chyle.
This is the cause of death in what is called ^.trmphyy both of
adults and of infants ; in the latter it is a frequent occurrence.

What is called " dying from nervous exhaustion," means that
a long course of imperfect nutrition has gone on ; that poor and
defici r,t blood has deposited poor and deficient solids ; that the
nervous solids have partaken of this imperfection to such an ex-
tent, that they are unable any longer to impart that energy to the
muscular and other moving solids which enables them to continue
the circulation of blood. This last failing in the brain, the ani-
mal, and then the organic being dies, — ^not so much of nervous
exhaustion as of insufficient nutrition. It is the kind of death
which terminates the chronic sufferings of those whose over-
wrought intellect or feelings have annihilated the digestive powers
of their bodies, and of others who have arrived at the same end
by the more material excesses of child-bearing, child-nursing,
and amorous propensities : all act by impairing the digestive en-
ergy. In short, in this and the two modes of death previously
cited the patients die of starvation.

2. The passage of chronic disease into organic is not difficult
of explanation, according to the doctrine laid down in the earlier
part of this volume. The morbid nutrition going on in the dis.
eased organ, wherever that may be, and dependent on the vitiated
vitality of its blood-vessels and organic nerves, is aided by disor
der at the centre of nutritive life, the digestive organs, where
morbid coction of the food entails morbid blood to flow through
the system and flourish the organ already exhibiting an unnatural
slate of nutrition in its tissue. If the patient have no hereditary
tendency to deposit tubercular or schirrous tissue, simple excess
of deposit of the natural tissue (simple hypertrophy) generally
ensues and constitutes the organic change ; in which case the
mass of circulating blood not being so much diseased as in the
constitutional tendencies alluded to, the local derangement of nu-
trition suffices for excessive deposit of the natural tissue alone,
and not for unnatural deposit. Hypertrophy of the brain, nmpU

56 THB GAirSBS, PROaRESS, AND ,

acUve enlargement of the heart, swollen Hver and spleen, and thick
ening of the mucous memlnranes, are instances of this kind of or-
ganic disease ; the effects of which on the general system may be
palliated for years, and even some reduction may be made, by
nice art, in the enlarged structure itself. When the hour is
come for it, hypertrophy of the brain kills by causing pressure on
and exciting inflammation in the brain and its membranes, the
result of which is also effusion and pressure ; so that the animal
is extinguished, and the organic parts, losing the vital stimulus
from that source, rapidly, though sometimes very gradually, sink
too. Enlargement of the heart, swollen liver and spleen, destroy by
inducing congestion and dropsy of the trunk and limbs ; they all
obstructing the free return of blood to the heart and through it, the
blood therefore remains in the small vessels, which become con-
gestive, and relieve themselves by pouring out the watery parts
of their contained liquid. But the former of these diseases also
kills by the lungs, the return of blood from which being ob-
structed, the patient is suffocated either by their inflammation oi
by pulmonary apoplexy, that is, effusion of blood, into the spongy
texture of the lungs. It is obvious that thickening of the mucous
membranes is fatal, by virtue of preventing the functions of the
important viscera in which those membranes play the most es-
sential vital acts ; upon these individually it is at present unne-
cessary to expatiate.

Where the organic disease consists not in a simple enlargement,
but in utter disorganization of a part, death takes place in conse-
quence of excessive irritation and oppression of the brain and
spinal cord, or by similar oppression induced by the retention in
the blood of elements which ought to have been eliminated by the
morbid organs. Instances of this are the disorganized and hard-
ened liver and disorganized kidney. In the former, the elements
of the bile — in the latter, those of the urine, are carried round
with the circulating blood, and either produce inflammation and
effusion on the brain, or else the bile and urine are actually de-
posited in the brain matter, whose function they effectually stop
by their presence. In the one case, bile is seen, in the other,
urine is smelt, in the brain. It should not be kept out of sight
that, in such cases, chronic digestive disease has long preceded
and now accompanies, and that deficient nutrition plays a part
in the fatal result.

That result is, if possible, still more certain, where the organia

TSBICINATIONS OF CHKONIC DISEASE. 57

disease is of Uibercular or cancerous character ; for in that case
the whole mass of blood is diseased — the whole nutrition of the
body is unnatural, and even if it were practicable to change thai
ibass, the organic tendency remains and cannot be changed.
Yet the mere deposit of tubercles and schirrus is not in itself fa-
tal : if by any means the inflammation of those morbid structures
could be prevented, they would be compatible with life. Un-
fortunately, the very fact of their morbid character renders them
less able to resist the causes of inflammatory action than the nor-
mal textures of the body. Themselves the product of deteriorated
vital energy, they exhibit the least possible energy in opposing
lind casting off irritating agents, even the least so. Slowly in-
flammation is established in them, and surely it saps the founda-
tions of life. No matter where the morbid deposit be, — ^tubercles
in the knee joint (white swellijig)^ or cancer in the nose, — ^an ex-
quisite sympathy with the stomach is maintained, a stomach that
had long been in a state of chronic disorder.

The immediate process by which life is extinguished in such
cases is a periodical attack of fever ending in profuse perspira-
tion, and by the generally enormous discharge of fluids from the
diseased points. The waste consequent on these two exhausting
processes leads to an increased activity of the digestive organs to
replace it. In' tubercular consumption of the lungs, of the knee
joint (white swelUng), of the bones of the spine (lumbar abscess),
as weH as in open cancerous ulceration, the appetite is ofttimes
very great, and not unfrequently extends to alcoholic stimulants.
After a time, however, the digestive power of the stomach, un-
naturally taxed as it had been, gives signs of diminution ; add to
which, that th^ excess of labor to which it has been subjected
tends to increase the inflammatory irritation of the stomach which
preceded and now accompanies that of the diseased tissues. The
event is, that waste by the lungs, &c,, goes on faster than supply
f^rom the digestive apparatus ; blood becomes deficient in the sys-
tem I the animal nervous system, the brain and spinal oord, feels
this the first, having the greatest need of a fbll supply of it, and
dies fk)m want of nutrition. In pulmonary consumption, more-
over, the failing nutrition of the brain and spinal cord causes
ftilure ef the nervoui energy sent to the muscles which move

the chest and effect expectoration, u^ ^"^^ ^*^S^. ?''*''^J.''^
•ecretion rising into the air-tubes, the patient is unable io ulSett*
fage It thence, and suffcwation takag ukpe-

4*c;/. •' . .,

58 THE CAUSES, FBOGB£SS> AND

Such is the end of chronic disease terminating in organic
change : and it bears out the assertion that, as during the time
the disease remains a functional one, it does so by virtue of the
morbid irritation of the central nutritive organ, the stomach ; so
when it has passed into the stage of organic disease, death tsckes
place from exhaustion of that organ, and consequent failure of the
process of nutrition.

3. The termination of chronic disease in ap9plectic congestion
and functional stoppage of some important organ is instanced in
apoplexy of the brain and of the lungs. The former supposes a
long previous irritation of the stomach and liver, the organic
sympathy between those parts and the brain maintaining the lat-
ter in a state of super-vitality and drawing to it an excess of
blood, the pressure of which at length annihilates the brain func-
tion ; or the sympathies with the stomach induce slow inflamma-
tory action in some portion of the brain, disorganization takes
place there, and rupture of more or fewer blood-vessels ; and the
outpoured liquid acts, as the excess within the vessels did, by
pressure and extinction of the cerebral function.

A process in some degree similar takes place in pulmonary
apoplexy, in which the outpouring of bloody secretion or the
bursting of sundry blood-vessels into the spongy texture of
the lungs renders that texture solid, impedes the entrance of
air, and respiration — prevents, therefore, the chemical changes
necessary to be operated by the air in the blood so as to ren-
der it fit to nourish the body, thereby stops the brain function,
and kills the aniijnal. The rapidity of this morbid act varies. As
a consequence of chronic disease of the lungs only, it is often slow,
and in that case it is more usually brought about by a gradual
secretion of sanguineous liquid from the inflamed \ir- vesicles of
the lungs ; but it is sometimes the consequence of organic obstruc-
tion in the heart, in which case it is generally fatal in a very
short time, not unfrequently in a few minutes. The organic
change in the heart which causes this catastrophe is for the most
part ossification of the valves of the aorta, and thickening of the
muscular substance of the heart.

4. Chronic disease of the abdominal viscera sometimes ends in
ulceration of their mucous or lining membrane, which eats through
its substance and allows its liquid and solid contents to be poured
into the cavity made by the peritoneal or investing membrane.
The result is immediate and rapid inflammation of that membrane,

TBRMJNATIONS 01 CHEONIC DISBASB. 50

vomiting, fever, and death, in a few hours. The most isual
localities for this ulcerative inflammation are the stomach,
especially towards its lower or duodenal end, and the lower or
great intestine. From the former the food and mucous secretion
is poured out through the ulcerated orifice, and from the latter the
mucus and feeces. Sometimes volumes of air escape from the
bowels into the same cavity, or are secreted in it ; but this is not
necessarily fatal.

In the lungs, chronic irritation, especially if accompanied
with asthmatic breathing, sometimes ends in perforation of the
sides of the air-tubes and vesicles, and the escape of air into one
of the cavities of the pleura, the consequence of which is con-
tinually increasing oppression of breathing, the air outside of the
lungs pressing upon them so as to prevent their expansion, and
this goes on to suffocation.

In these various terminations of chronic disorder we have the
exemplification of the fact insisted on in these pages, that '< death
comes only by the viscera;" and that, as the disorder of those
organs, in their character of centres of nutritive activity, main-
tains chronic disorder in other parts, by maintaining nutritive
disturbance there, so, when their own chronic disease terminated
fatally, it is by arresting their own nutrition, and, ipso fcLcto^ that
of all other parts of the economy. It is reasonable to suppose that
the same central nutritive organs which have for years kept up
morbid sympathies all over the frame, should, when worn out of
their nutritive energy, draw all other parts with them into extinc-
tion. Gout in the foot never kills, but gout in the stomach does ;
and why? Because so long as the irritation of the digestive
organs, which is the essential of gout, is thrown upon^he foot,
those organs are safe. But when they have no longer energy to
do this, the disease oppresses and arrests tkeir nutrition, and all is
darkness and destruction for the rest of the body. Truly these
viscera and these visceral ganglionic nerves deserve more notice
and better usage than they generally get! And they should
always be thought of in conjunction. It is because '* the stomach
and bowels" are in view, and not the myriads of exquisitely sensi-
tive nerves which endue them with life, that such monstrous
medicinal extravagances are practised on them for months together
as to astound one at the reckless courage that prescribed them.
One stands aghast at some of them !

So much for ihb fatal terminations of chronic disorder, to whicb

do THE CAUSES, PROGRESS, AND

it is most ordinarily driven by the irrational system of meddling
with every symptom, great or small, which may arise — ^that nimia
diligentia, for which both patient and physician are often responsi-
ble; the latter listening to the impatience or prejudice of the
former rather than to his own judgment. To this may be added,
the persistence in the causes of the malady, improper diet, bad
habits of life, excessive mental toil, &c. Indeed, the two play
fnto each other's hands ; the essential of the disease inveterates,
and the symptoms multiply because the causes are maintained in
action ; and patients are led to continue, or to make no effort to
cease, these last, because they find in medicinal means a way to
lull for a time the urgency of individual symptoms. And so the
mischief accumulates, until an organic disease puts the long-
cherished self-deception to flight, and places death vts-d^vis the
alarmed and doomed sufferer.

But where nature is afforded the opportunity of exerting the
strong conservative faculty she possesses, by withdrawing the
exciting causes on the one hand, and by ceasing the perturbing
influences of complicated medication on the other, she not unfre-
quently brings about a recovery, more or less complete, accord-
ing to the quantity of the faculty in question that remains. If
the organization, and, consequently, the vitality of the viscera,
which are the seats of this faculty, have not been already too far
deteriorated by the agencies just mentioned, an effort is made to
transfer the chronic irritation of the viscera to some less impor-
tant organ oi organs, which usually relieve themselves of this
transferred action by the outpouring of some secretion, generally
excessive in quantity and morbid in quality. Thus it is that
sweating, purging, and large secretion of turbid urine terminate
certain chronic diseases favorably ; the irritation of some vital
organ being thrown respectively on the skin, the lower bowel and
the kidneys, and the gorged skin, and mucous membrane of the
colon and kidney pouring out excessive materials in order to re-
lieve themselves. Sometimes the effort of removal is so sudden
and great as to excite perturbation of the entire nervous and cir-
culating systems, and the series of turbulent phenomena called,
collectively, /ercr, are exhibited ; which end, however, in sweat
bowel, or kidney secretion, or occasionally in all three. At other
times, the internal congestion of blood which constituted the
chronic disorder is, by a slow process, converted into a conges-
tion of the skhi, and more especially in certain points of it, faum'

TERMINATIONS OF CHRONIC DISEASE. 61

ing, if the congestion be superficial, some efflorescence or erupt*
ive display ; or, if it be more deeply seated, collections of pus,
boils, d^c.

It appears, then, that spontaneous and extraordinary secretion
from the skin, from the mucous membrane of the lower bowel,
from the mucous membrane of the kidney, an attack of fever,
various eruptions of the skin, are the most ordinary of the yavor-
able terminations of internal chronic disorder. I have not men-
tioned in detail the cases in which each of these terminations is
most common and most effectual, because I shall have occasion
to do so in speaking of the individual chronic maladies. Mean-
while, let it be borne in mind that each and all of these termina-
tions have occurred, and may occur, without the intervention of
any art, save that of removing the causes, and by ike sole effort
of nature. The annals of medicine aflR)rd abundant instances
of the removal of inveterate and serious internal maladies by
the supervention of itch, of external abscesses, of small-pox, of
inflammatory fever, and of copious sweating, purging, and mic-
turition, at a time when all remedies had been .laid aside as
useless, and attention paid only to the avoidance of those things
which palpably exasperated the malady. . This was and could
only be the result of that uprising of nature to throw off the dis-
ease which, if continued, must prove fatal to vital parts, to which
allusion has been already made ; and which, often before but
unsuccessfully attempted, at length did rid the vital organs of
their ** perilous stuff" and destructive action. And remark,
that this conservative power can only be successfully exercised
when the original irritating causes are removed, when the addi-
tional irritating cause of medicinal meddling with the viscera is
avoided, and when the viscera, at rest from excessive stimulation,
and called upon to enact only just so much of their functions as
is necessary for the maintenance of the organism, accumulate
in time sufficient vital energy to make the final, the critical effort
£)r their own preservation.

Now, this natural eff)rt, this self-preservative process, is pre-
cisely imitated and aided by the rules and appliances of the
water cure : imitated, inasmucli as, observing what is the natural
crisis of each disorder, the means are applied which tend to the
production of it ; and aided, inasmuch as, in consequence of the
•rtistical and strict removal of exciting causes, by which the
body ifl placed in the best condition to aid itself, and in conB»

t>2 THE CAUSES, PROGRESS, AND

quence of the additional tone given to the franne generally, aed
the derivation made from the diseased organs by the details of
the water treatment, by which the efforts of the body are seconded,
the time necessary for the production of the natural favorable
termination is considerably reduced. All this will receive fur-
ther development in these pages. It is mentioned here, because
it is impossible for one who knows the agency of the water treat*
ment, to avoid allusion to the complete parallel between the ways
taken by nature, and the means included in that plan of treat-
ment whenever the subject of the natural and favorable termi-
nations of chronic disease is brought forward.

Other favorable terminations of chronic disease are to be
noted, which are, or appear to be, independent of any transfer to
the external surface. Internal ulcerations are known, on some
occasions, to have healed. Thus, the inspection afler death of
the stomachs of individuals who had suffered long from dyspepsia
has exhibited in the mucous lining of that organ marks of heal-
ing afler ulceration ; but it does jiot appear that any notable ame-
lioration of the dyspeptic symptoms attended it, and it may be
quoted rather to establish the possibility of the healing of inter-
nal ulcerative inflammation, the tendency of which is mostly
mortal, than for any practical application that can be made of it.
We can only give a wide conjecture, during life, that such a
saving process is going on ; and, if we knew, it would only alter
our prognostication of the result of the malady — not help us in
the treatment of it.

The same applies to tubercular ulcerations of the lungs, traces
of the healing of which, at some long period before, have been
discovered afler death. These are the only instances of pulmo-
nary consumption being cured, — cured by nature, for the physi-
cian was not even aware of what is going on in these cases. It
is, therefore, impossible to say under what circumstances this
favorable event of a deadly malady took place ; but it should be
stated, that the ulcerated cavity in all the cases on record must
have been very small, judging from the mark of the cicatrix left
behind — ^in no instance larger than a horse-bean. Scant ground
this on which to build a hope in so invariably destructive a
disease !

There is one organ, the liver, which occasionally rids itself of
chronic disorder without transference of irritation to other or-
gans ; and it does so by the simple outpouring of its own secre-

TBRXIKATIONS OF CHEONIO DISBASB. 09

VKMy the bile. This is shown, in the improved charactei of the
evacuations from the bowels, which come to contain more bile
than heretofore— of the urine, which now contains less— of the
skin, which, from yellow, becomes clear — of the taste, which
ceases to be pervaded by bitter, d^c. ; and all this without any
diarrhcsa or sweating that could call attention. The organ would
seem to have accumulated sufficient ganglionic vigor to recom-
mence the due performance of its function. The circumstances
which bring this about will be given when speaking of the chronic
maladies of the liver. Meantime, it may be mentioned that the
morbid condition which can be obliterated by this process, inde-
pendent of all critical transfer, is, as might readily be supposed,
of no very intense or long persistent character.

This terminates what is necessary to be said on the subjecUi
included in this chapter. These subjects-— the causes, progress,
and terminations of chronic disease-— might be made to occupy
the entire of such a volume as this ; but besides that, in such
case, much verbosity would be perpetrated, the treatment of a
subject generally, calls only for the enunciation of points of simi*
larity, leaving the points of divergence to appear in treating the
different parts of the subject individually. The general facts of
chronic disease have been here announced without any attempt
at extension, which, after all, might only have rendered the
matter more obscure by complicating the manner ; whereas, as
they stand, they will be found, I believe, sufficiently intelligible.
Besides which, the pretensions of this volume altogether are only
those of an elementary, not of a systematic treatise. Yet is the
subject of chronic disease well worthy of the latter ; and it is to
be hoped that a writer worthy df the subject may be found.
The outlines, at least, will be found in the preceding pages.

PART II.

OF PARTICULAR CHRONIC DISEASES, AND THEIR
TREATMENT.

CHAPTER I.

DISEASES OF THE PRIMARY NUTRITIVE ORGANS.

Reasons for placing the digestive or primary nutritive organs in the first
place for consideration— Basis of arrangement for diseases of other or-
gans — Mucous and nervous indigestion— Fallacy of old definition»«
Efiects treated as causes — ^Rationale of symptoms — Sinking, fulness,
gnawing, and spasm of stomach— Flatulence — Excessive and deficient
appetite — ^The throat, tongue, gums, and teeth, in dyspepsia — Symptoms
in eyes and ears — Symptoms indicative of morbid sympathy with brain
and spinal cord— Comparative results of mucous and nervous dyspepsia-
Rationale of treatment— Cases in illustration.

The general development of the subject of chronic disease given
in the antecedent chapters affords a sufficient reason for the ar-
rangement of the individual diseases which it is my purpose to
make. We have seen how disease commences, in the great ma-
jority of instances, in the central organs of life — ^the digestive or.
gans ; and how, when it commences elsewhere, its chronic cha-
racter is determined by the implication of the digestive organs.
No pathological fact is better established ; and it would suffice to
place their maladies in the first order for examination and eluci-
dation. But physiological considerations also strengthen their
claim. Dependent as the entire organism is for its functions on
the due supply of blood, as regards quality and quantity, the di-
gestive organs, in which the primary elaboration of that liquid is

M DISEASES OP THE

efl^ted, necessarily influence the very first condition of vitality
in all other organs. If the condition of the stomach be such as to
preclude the digestion of food, or to produce a bad digestion of it,
either no blood at all is formed, or blood of a bad kind, unfit for
the purposes of nutrition, and the organs of the whole body lan-
guish, or are diseased in their nutrition. In this manner they go
far to regulate the nutrition of the rest of the body ; and as the
pabulum for nutrition is first made in them, they claim the appel-
lation of " primary nutritive organs."

Further, the digestive organs influence the other parts of the
body by the fact that in and about them is the central portion of
that ganglionic system of nerves whose office it is to regulate the
distribution of blood in, and therefore the mode of nutrition of,
each organ, however near or distant. By virtue of this system,
not only do organic sensations proceed from the stomach to the
remotest portion of a limb, but the nutritive activity of this last is
conveyed to and recognized by the stomach. When the stomach
has been for a long time without food, the feet become cold — ^in
other words, the circulation of blood in them is diminished, and
the heat, given out from the blood, also diminished — an organic
sensation has proceeded from the stomach to the foot. When in
such a state the limbs are exercised in walking, &c., the want of
sufficient nutritive liquid in the limbs so in action is announced
to the stomach by an organic sensation transmitted to it by the
ganglionic nerves, and the result of which is to beget hunger in
the stomach in order to urge the formation of more blood. And
so of every organ of the economy. So that whether the digestive
organs be looked upon as the primary laboratory of the blood
which is to nourish the whole frame, or as the centre of the sys-
tem of nerves which is to regulate that nutrition, we behold in
them the starting and converging point of all healthy, as of all
diseased life, in the various viscera, limbs, and covering of the
body.

On these grounds I propose to speak, in the first place, of the
ehrardc diseases qf the upper organs of digestion. In the preceding
chapters, the extension of disease thence to other parts is dwelt
upon and explained. The arrangement of this part will proceed
partly on the facts of that extension, and partly on the physiolo-
gical processes of nutrition ; and doing this, I shall speak, in the
next place, of the maladies attached to the heart and lungs,
those being the organs which come next in the great process of

PRiMART NUTRITTTB ORGANS. tH

nutrition, and towards which the extension of digestive disorder
IS first and most frequently made. Afler these will come the
chronic diseases of the chest ; then those of the nervous system ;
afterwards, the extension to the limhs, as shown in gouty rheuma*
iism, and simple inflammation of the joints; next those of the lower
organs of digestion, the colon and rectum; and, finally, the exten-
sion to the outer mucous membrane of the body, as shown in skin
diseases,

I haye no intention, howeyer, of entering upon all the diseases
incidental to the organs above enumerated, but only such as have
fallen under my observation, and been treated by the appliances
of the water cure. But as each disease comes to be treated of, I
shall first give a history and explanation of its symptotbs, so as to
render the application of the remedial means, subsequently de*
tailed, intelligible to all readers. One great object, in my view,
is to afibrd such readers a truthful and rational exposition of
the chronic maladies that are most commonly met with in civil-
ized society, and, by that means, to enlighten them as to the mode
of preventing as well as curing them, by natural rather than me.
dicinal means, though not as to the mode of being th#lr own phy-
sician. This, I apprehend, will be done by exhibiting the origin,
tracing the progress, and giving an explanation of the phenomena
of each disease under notice ; to which will be appended one or
two cases in point, as practical examples of the previous general
history and exposition. This will form the subject matter of the
present part. The third knd last part will come in aid of it, in
the aim of prevention as well as cure, not by mere enumeration
of the processes of the water treatment, but by showing how the
employment of them, at an early period, eradicates the predomi.
nant mischief speedily, and, what is almost of more consequence,
tends to the generation of habits and tastes that are altogether
alien to the' recurrence of the causes which originally produced
the disease. For the water cure differs from other modes of
treatment, by its much greater stringency regarding the with-
drawal of causes, and by its strict reduction of habits of life to
the simple natural standard, which both leaves the system free to
relieve itself from the disease that weighs upon it, and rids it of
the slavery of artificial excitants under which it groaned.

The first diseases of the primary nutritive organs which oomo
to be mentioned,

08 MUCOUS AND NBRVOUS INDIGESTION.

§ 1. Mucous and Nervous Indigestion,

Under the generic name of Dyspepsia, these two forms of indi-
gestion are very commonly spoken of and practically treated.
Yet there are well marked pathological distinctions between
them ; they demand different treatment, and they lead to different
results. This I shall be able to show ; but I would desire first
of all to dissipate some vulgar errors that obtain regarding this
wide-spread plague of civilisation— dyspepsia.

A man with Cullen's definition of indigestion in his head —
"loss of appetite, nausea, acidity, flatulence, &c." — is firmly
convinced (hat he has to treat every one of these symptoms ; and
he does so treat them, giving a separate remedy for each — bitters
for the appetite, effervescing draughts for the nausea, soda for the
acidity, ginger for the wind, and so forth. In his mind the ag-
gregate of these symptoms makes an entity which he calls dys-
pepsia, a sort of being which he is to annihilate with varied
weapons. This is one error : it is held by many medical men,
and cheris^^ by very many patients, who admire the complex
piedication to which it leads.

As a kind of pendant to this, is the error of fixing on one symp-
tom, and calling it the cause of the disease — ^the old error of
short-coming knowledge, of taking the effect for the cause. One
says the flatulence causes his disease, another the nausea^ a third
the acidity, and so forth. This leads to the lay treatment with all
manner of alcoholic, peppery, and cordial stimulants, alkalies,
magnesia, &c.

In some forms of dyspepsia there is loss of appetite and loss
of alacrity of limb. The one is attributed to " want of tone" in
the stomach, which is true as regards the capillary blood-vessels,
as I have shown, but erroneous in the sense in which it is said —
namely, as denoting a necessity for tonic stimulation. The other
is attributed to debility, and upon this error is built the necessity
for high feeding.

In another form of dyspepsia the appetite is excessive — far ex
ceeds the digestion. Yet this, too, is looked upon as a reason for
hecatombs of food ; and, as the limbs become less powerful un-
der this diet, the erroneous conclusion is arrived at that enough
has not been eaten !

Lastly, there is the error of mistaking fat for flesh, and volume
for vigor. A fat red-faced dyspeptic, suffering torments which

MUCOUS AND HERVOUS Of DIOS8TI01I . W

his face belies, but with which that face is, as I shall show, donly
ooimected, is generally much pitied by friends when the redness
and bulk diminish, though it is often accompanied by diminutioa
of suflTering ; so that just when nature is curing his malady, she
is marred by the recommendation of anidous people to " take
something to get^ up his looks again" — ^that something " getting
up'^ the old irritation also.

These erroneous notions are sad drawbacks to the successful
treatment of indigestion. The prejudices which they represent,
if opposed by the medical attendant, are too strong not to throw
disorder into the nervous system. The patient fidgets about the
" acidity" or the " flatulence," because his old remedies for them
are withdrawn ; and this fidgeting induces nervous unsettlement
and increased stomachal sensitiveness. And if not opposed, or
if seconded by the attendant, the same result comes more speedi-
ly and more intensely. The only remedy for this state of things
is to describe to the patient, as clearly as may be, the essential
nature of his disease ; to show him how these various symptoms
which he mistakes for causes, spring from that essential nature ;
and thus to draw the ground from under his prejudices, and pre-
pare him for rational instead of empirical treatment. Let us
proceed to do this.

Reverting to the first part of this work, it will be found that acute
disease always precedes chronic disease (page 2) ^ and that the
great characteristic of acute disease in a part is an excess and con-
gestion of blood (page 6) ; that chronic disease is an extension in
degree of the acute (page 13) ; and that in both, but in diflerent
degrees, there is a loss of organic sympathy between the blood-
vessels and their contained blood, leading to an imperfect vital
chemistry, and consequent bad nutrition and secretion (page 14).

Now, what is called chronic dyspepsia means, when reduced to
its essence; a chronic excess and congestion of blood in the nutri-
five blood-vessels of the mucous membrane of the stomach, or of
the ganglionic nerves that surround and supply the stomach.
The effect of this congestion is to interfere with the quality of
the blood, and its organic sympathy with the vessels which con-
tain itJ As all secretions are derived from the blood, we might
expect that they would not be of a proper kind when proceeding
from blood so circumstanced. Accordingly, instead of the ordi-
nary insipid, mucus, there is at one time acid mucus poured ou^
forming the addUji so much talked about by dyspeptics, a^d

TO XUCOUS AND KEEVOUS INBlGESriON.

which, as the membrane which secretes the spittle is a continua*
tion of that which lines the stomach, is also experienced in the
mouth. At another time the power of the ganglionic nerves over
the vessels of the gastric mucous membrane is so irregularly ex-
ercised, that, instead of mucus, the elements of mucus, in the
shape of gases, are poured out from the blood, and the much*
dreaded Jlatulence is produced.

Now, suppose a quantity of this acid, or volumes of this air,
secreted in a stomach lined with mucous membrane, on the outer
side of which is a thin layer of muscular, moving fibres, whose
office, in health, is to contract and move the food about in the
stomach. The acid and the air, being unnatural matters, bring
these muscular fibres into an unnatural state of contraction, and
tpasmodic contraction of it takes place ; according to the degree
and exact locality of which is the sensation produced. If the
middle • part of the stomach b the seat of spasmodic contraction
(as usually happens in acidity), there is a sense of dragging or
gnawing at the pit of the stomach, or a pain in the ' hreasthane
above the pit of the stomach. . If the great sac or lefl end of the
stomach contracts morbidly, it drags upon the passage from the
stomach to the throat, and the sensation called hearthum is expe-
rienced — a mixed sense of acute pain at the pit of the stomach
and drawing in the throat, and occurring mostly when wind is
present. Sometimes these pains are sufficiently acute to be felt
completely through to the back, between the shoulder blades.

The spasmodic contraction of the stomach thus produced has
various degrees. One of these causes the sensation of hunger.
Natural hunger is nothing more than a greater than usual con.
tractile movement of the empty stomach, a sort of slight cramp,
which is relieved when the hollow muscle, the stomach, has some-
thing to contract upon. For this purpose anything will do, from
water to pebble stones. In confirmation of this view of the phy-
siology of hunger, it is found that pressure on the pit of the sto-
mach, with the hand or a bandage, suspends the sensation by
allaying the crampish movement, just as pressure on the calf of
the leg subdues the cramp there. Also, it is known that smoking
tobacco or swallowing opiates, or any other antispasmodic reme-
dies, suspends hunger. Instinct, too, leads many hybemating
animals to swallow rosin and other indigestible matters previous
to entering on their long torpor, which might otherwise be dis-
turbed by the spasmodic cravings of an empty, hungry stomaoh*

Jlti;C0US AND NBSVOVS INDIGESTION. 7]

Well, then, we have a dyspeptic, irritable stomach, containing a
mass of undigested food, or a quantity of acrid, irritating mucus,
or a large volume of wind, or all three together ; any one of
these may suffice to violently irritate the muscular coat of the
stomach, and produce the amount of spasmodic contraction which
corresponds to the sensation of hunger. Hence it is that dyspep-
tics so often have craving for food immediately after a large meal
of it, and at the time when it remains untouched by the digestive
office of the stomach. Hence it is that immense appetite is so
often a symptom of the most intense dyspepsia. But reference
must be ever had to the antecedent cause of the acid or wind, and
the spasm they induce ; and that cause is inflammatory conges-
tion of the mucous membrane, or of the nerves of the stomach.
The want of this is the foundation of all the gross errors that
distinguish the ordinary treatment of indigestion. A stimulating
antispasmodic gives the whole stomach the temporary power of
getting rid of wind, or a dose of soda neutralizes the acid, which
then ceases to irritate, and the gnawing, dragging, or hunger, dis-
appear. Not so the cause of them, which these remedies have
rather exasperated ; as is shown in the fact that the doses have
to be repeated more and more frequently, until soda is taken in
every beverage, and sal volatile, ginger tea, or pepper lozenges,
at every hour of the day.

Another and greater degree of spasmodic contraction of the
stomach causes the sensation of nausea ; and this degree calling
the surrounding muscles of the belly and chest by sympathy into
a similar state, the act of vomiting is produced. But between
that and nausea there is the partial contraction, which suffices to
throw some food, sometimes insipid, sometimes acrid, back into
the mouth, constituting the eructations that form one of the great
distresses of dyspeptics. Hiccup is when the spasm is about the
upper orifice of the stomach, where the gullet expands into that
organ ; it then involves the midriff, and that powerful muscle aids
in the violent convulsion that marks the act.

Lastly, there is the actual spasm of the stomach, where every
muscular fibre of it is in the most intense state of contraction,
precluding the exit of anything whatever, solid, liquid, or aeri-
form, from its cavity, and inducing the most alarming sympa-
thies in the organs of the chest, and in the brain. It is most apt
to occur in gouty persons ; but others are liable to it.

But sometimes the congestion of the nerves of the stomach i»

73 MUCOUS iND KSBVOUS INDI6BSTI01I.

80 great as to oppress their function, to prevent them from send
ing to the muscular coat of the stomach the due contractile
energy. In this case there is loss of appetite. Between this
state of the nerves and that which causes craving, there is the
same difference as between the condition of the brain which
causes delirium, and that which is accompanied by stupor ; in
the former there is an excess of blood, enough to produce excess
of brain function ; in the latter there is a greater excess, enough
to oppress the brain.

Thirst is an occasional symptom of indigestion. When the
irritation of the stomach is greater than usual, it acts as a stimu-
lant to the blood-vessels of the membrane which lines the throat,
causes them to contract, and thus diminishes the secretion of that
membrane, which becomes dry. That such is the fact is shown
by another fact, namely, that washing the mouth, or gargling the
throat with cold water, will relieve the thirst. It is a more con-
tinued symptom of mucous, than of nervous dyspepsia ; but when
it occurs in the latter, it is much more intense and pressing for a
time.

With the deranged ganglionic power, deranged secretion takes
place, as we have seen in the stomach itself. But the same
holds with regard to the membrane which lines the fauces, the
mouth, the tongue, and the eyelids : for it is a continuation of the
same which lines the stomach. Accordingly, we find in dyspep-
sia, either deficient or diseased spittle, very frequently thick and
tenacious, less frequently thin and acrid — ^the former in mucous,
the latter in nervous indigestion. The spittle also tastes acid,
bitter, metallic, sweet, mawkish, &c. ; which no doubt is owing
in part to the disordered sensation of the nerves of taste, and
partly to the morbid secretion. Further, the vapor from the
membrane of the throat and jaws is more or less foBtid, causing
a tainted breath ; though this symptom is often wanting. For a
like reason, namely, the congestion of the membrane in question,
dyspeptics are much liable to sore-throat, both relaxed and in-
flammatory, from variations of weather.

Following the membrane from the throat forwards, it covensi
the tongue, — ^the well-used indicator for the doctor. To go into
details on this point would be tiresome, and I shall content my-
self, and the reader too, probably, by stating the general result
of my experience' of the tongue as a symptom in chronic in
digestion.

MUCOUS AlfD NEEVOUS IMDIGBSTIOK. T9

1. When the tongue is not much, or not at all increased in
redness or volume, but has a thickish, whity-brown fur upon it,
without any great amount of dryness, we may infer that the
stomaeh irritation is of the mucous membrane, and not of an in-
tense nor ancient character.

2. When the fur in question is slimy, and the tip and sides of
the tongue that are uncovered by it present a vivid redness, the
dyspepsia is of the mucous kind, is intense in character, and is
of longer duration.

3. If, with this last appearance, the fur be yellowish, though
more dry, the liver and duodenum are involved in the dyspeptic
disorder.

4. When the tongue is clean, but vividly red, with the pa-
pilla at the tip elevated, and of the ordinary moisture, a recent
nervous dyspepsia may be predicated.

5. When this red tongue is dry and glazed, a more intense
degree of the same dyspepsia exists.

6. When the very red tongue has a slight degree of whitish fur,
and is enlarged in volume, it bespeaks a very intense nervous
dyspepsia, sufficient *o involve the brain, which, in such case, is

7. The most intense degree of nervous dyspepsia, however,
shows a considerably enlarged tongue, the face of which is split
into furrows in all directions, so deep sometimes as to give the
appearance of several small tongues just holding together by
their edges.

8. When nervous and mucous irritation are both intense, and
have endured for a long time, the tongue is red at the tip and
sides, covered in the centre with a very thin, white, shining mu-
cous coat, and is enlarged. This silvery tongue (literally, not
figuratively) denotes a great amount of long-standing dyspeptic
irritation to be eradicated. It is a common tongue with hypo-
chondriacs, especially such as have undergone courses of mer-
cury, and is always connected with morbid action of the brain.

This enlargement of the tongue is so strictly connected with stomach
irritation that the tongue will sometimes swell after each meal, and de-
crease when digestion is over ; in coincidence with the excitement or rest
of the digestive organs. Moreover, a process of the water cure will cause
a contraction of the tongue for the time, by decreasitig the stomach irri-
tation. A medical gentleman now under my care has remarked both
these facts, and reported them to me.
5

74 MUCOUS AND NERVOUS INDIGESTION.

Other peculiarities of the tongue are its indentation at the sidesi
which implies its au^en/ecf volume ^ and pressure against the teeth ;
and its iremuhusness on protrusion, which usually indicates nervous
dyspepsia, that has involved the spinal cord. But of the signs
above-mentioned, one of the most important is the increased size
of the tongue, which so often goes unnoticed. Yet have I seen
cases of the most distressing indigestion, where the thickening of
the tongue was the only sign it afibrded, being in color, moisture,
and cleanness, perfect ; and, what is more curious, in these cases
the dyspepsia diminished with the diminution of the tongue,
which, however, became furred and rather clammy, seeming to
show that this latter kind of tongue is that of a minor degree of
stomach irritation. It is too much the custom to look for fur of
the tongue as the only sign of chronic diseased digestion ; whereas
it is the accompaniment of the least tedious and intractable forms
of it; your silvery, or your clean, red, swollen tongue, is far
more difficult to manage than the ordinary foul " wash-leather"
tongue.

The gums and teeth afford signs of dyspepsia ; the same mucous
membrane which covers the tongue, and lines the stomach, passing
over the gums, dipping down the sides of the teeth, and sending a
pulpy prolongation by the root of each tooth into its centre. This
arrangement renders it sufficiently easy to explain the redness,
swelUng, tenderness, sponginess, bleeding , and fcetor of. the gums ;
symptoms which attend, in great or. small array, most forms of
indigestion, especially of the mucous character. In nervous dis-
pepsia, the gums often lose their nutrition, and shrink from . the
teeth, leaving their roots bare. Neither is it difficult to com-
prehend how, with such a prolongation of the mucous membrane,
aching, decay, and discoloration of the teeth occur in dyspepsia.
Besides this, the nerve which passes directly from the brain to
the stomach sends branches, as it goes down the throat, to the
jaws, which branches give out a twig of nerve to each tooth. It
is easy to see how a draught of water, diluting some acid liquid,
or allaying some exasperated inflammatory action in the stomach,
may almost immediately soothe "a raging tooth," in which no
trace of decay could be found to account for the pain. Many a
noble grinder has been extracted, when the more pleasant opera-
tion of swallowing some iced water would have allowed it to re-
main in the jaw, and do good service for years to come.

At the point where the inner mucous membrane ceases, and the

MUCOUS AND NERVOUS INDIGESTION. 75

outer mucous membrane or skin commences — at the lips,-— there
is, frequently, accumulation of blood in the spongy tissue which
constitutes them. This fiery red, spongy lip occurs in recent
mucous disease, or in nervous dyspepsia, at any stage : it goes
with the red and spongy gums. Sometimes its covering membrane
partakes of the nature of skin, and throws off mucus, which coagu-
lates in the air, and forms dry flakes on the lips. . But when dys-
pepsia has been of very long standing, and has invaded the struc-
ture of the duodenum or liver, we have the lips at first marbled
red and white, and as the disease advances, the white predominates,
the lips, the lower one especially, becoming blanched, waxy, and
hard. This is the old drunkard's lip, and bespeaks irremediable
mischief.

Proceeding from the back of the throat to the nostrils, and
thence, by the passage for the tears, to the eyes, the mucous
membrane lines the eyelids, and covers the eyeballs to the extent
of the portion called "the white of the eye." Hence the hhared,
9vffused eyes of many dyspeptics ; the gorged, thickened, and
internally red, and externally dark eyelids ; the inflamed glands
at the roots of the eyelashes, accompanied by deficient or thick
gummy secretion there. And as these two surfaces — ^the inner
eyelid and white of the eye — work upon each other, the result of
their congested state is painful action, producing flow of tears, the
whole going by the name of " weak eyes,^' a symptom of very
common occurrence in chronic indigestion.

Itching of the nostrils, dryness, or, on the other hand, excessive
distillation from them, irregular sense of smell, all which take
place in dyspepsia, are accounted for by the extension of the gas-
tric mucous membrane to the nostrils. When the membrane is
gorged and thickened, the nerves of smell spread over it are
oppressed in their function, and deficient sense of smell is a dys-
peptic symptom. The same connection of membrane renders
dyspeptics very liable to take cold in the head, that is, to have
the lining of the nostrils gorged with blood, as the secondary con-
sequence of external cold.

Running up from the back of the throat to the Eustachian tube,
which is the avenue thence to the inner ear, the mucous mem-
brane here also is liable to variations with that of the stomach.
It may become dry, and then there is burning pain, and nciUe
sense of hearing ; or it may become gorged with blood, swelled,
attd; stopping up the passage, produce one species of deafness.

7(J MUCOUS AND NERVOUS INDIGESTION.

Irregularity of hearing is a symptom very often complained of by
dyspeptic patients.

Finally, the gastric mucous membrane passes over the spongy
bones at the back of the nostrils, and reaches and lines the hollow
space which separates the two plates of the' bones of the foreheaa
'— <Ae frontal sinus. This is the seat of sick headache, and of
^liUous headache, as irritation of the membrane of the stomach
itself, or of its extension to the liver, prevails.

So far, it will be perceived, the symptoms of dyspepsia arc
explicable, by the continuation of the inner surface of the stomach.
But, in thus tracing them by continuity of membrane, it should
never, for an instant, be forgotten, that the sympathies, healthy
as well as morbid, between the different portions of that mem-
brane, are due to the similar nutrition of them all under the direc-
tion of the ganglionic nervous system. It is the nerves of this
system which should be ever present to the mental eye of the
practitioner when he beholds, in the various signs I have detailed,
evidences of chronic dyspeptic disorder. Failing in this, he falls
into the worst errors of ontology, treating names instead of states
of action, and putting aside as non-existent the organic sensitive,
ness of the most sensitive membrane of the body, — ^the mucous
membrane of the digestive organs. We know not of such mem-
brane without myriads of nerves of organic life entering into its
intimate texture, and regulating all its vital actions. Not a tear*
distils from the eye, nor a drop of the wonderful gastric juice from
the lining of the stomach, save at the urgency of the ganglionic
nerves which supply the membrane of either organ.

Whilst morbid phenomena are proceeding in the extended .
membrane of the dyspeptic stomach, other symptoms, having no
dependence on such extension, are pressing. Such are the signs
that are exhibited by the brain and spinal cord, and are called
the nervous, or the brain symptoms of chronic indigestion. It were
vain to attempt the enumeration of all these fiigns, including, as
they do, every possible variety of sensation and diseased thought ;
and there is scarcely one, however extravagant, which some dys-
peptic or other has not experienced. Pains, shooting, burning,
cutting, drawing, lacerating,- &c. ; sensations of cold, heat, ful-
ness, emptiness, creeping, itching, gusts of wind, opening and
shutting, gnawing, roughness, trembling, &c. ; thoughts, de-
pressed, impatient, suspicious, selfish ; the mind indolent, vivid
to the last degree, perverted, or, on the other hand, with excen

XaCOUS AND NERVOUS INDIOSSTION. 77

of nataral tendencies ; the volition powerless, or, again, gpreat to
the point of constant restlessness. Such are a few of the pheno-
mena which show that the irritation of the digestive organs has
disordered the nutrition of the cerebral organs. But how diverse
soever they may be, they are all reducible, in their point of origioi
to three positions — viz., the spinal cord, the grey matter of the
brain, and the white matter of the brain.

As the spinal cord is the seat of the exercise of the will, all the
dyspeptic signs involving that mental function are referable to
morbid circulation and nutrition there. Irritations proceeding
from the stomach to the cord alter its healthy action ; the nerves
vrhich it sends out to the muscles of the body cease to receive
steady energy from it ; and thus, both in their sensations and in
their power in setting the muscles into action, they are disordered.
Hence the trembling of various parts which the will cannot com-
mand ',* the spasmodic and convulsive movements of a limb, or part
of a limb ; the occasional and Umporary palsy and numhness of a
limb, denoting irritation to the amount of pressure on the cord ;
and hence, too, the cramps, shooting, and other pains, cold and hat
feeUngs, dsc. And all of these may be confined to a small part
of the trunk or of the limbs, to a single joint, for instance, because
only a small part of the spinal cord, whence nerves are given out
which go to the joint, is involved in the irritative sympathy origi.
nally proceeding from the dyspeptic stomach. The long list of
hysterical symptoms, so oflen attendant on chronic indigestion, is
more especially traceable to this morbid sympathy between tha
stomach and spinal cord ; the startings, shudderings, uncontrolla-
ble laughter or weeping, being indications of the lost controlling
power of the spinal nerves. A like sympathy between the stomach
and spinal cord is the means of inducing the malady called
asthma, and other forms of difficult breathing ; as also stomach
cough, of the latter of which I shall treat more fully under, the
head of disorders of the respiratory organs. Meanwhile, as re-
gards the signs dependent on the sympathetic irritation of the

* That trembling depends on diminished power in .the seat of the will*
and cannot be resisted, these admonitory lines of Horace to Quintius would
amply:

** Neu, si te populus sanum recteque talentem,
Dictitet, occultam febrem sub tempus edendi
Dissimules, donee manibus tremor ineidat undis.**

Lib. i., EpistoL 10.

78 MUCOUS AND NBEVOUS INDIGESTION,

spine, it may be i-einarked how little is this sympathy ree(^Dized 1
and how often are the spines of dyspeptics blistered, leeched,
stretched, laid for months or years on inclined planes, &c., under
the plea of spiTud complaint, when a little more observation and
physiological deduction would have spared the spine, and dis-
covered a stomach at the bottom of all the mischief!

It should be mentioned that these disordered spinal phenomena
are most commonly connected with nervous dyspepsia.

The grey matter of the brain is the outer layer of that organ
and the physical agent of the mind. In nervous indigestion, mor.
bid sympathy is propagated to it, and morbid nutrition induced in
it, and the mind thus has an unfit organ to work withal. The
consequence is a series of mental feebleness and contradictions
that form a large portion of the misery of the dyspeptic. The
impatience, irascibility, caprice, anxiety about trifles, and about
self, suspicions, groundless fears, and similar marks of morbidly
Tivid mental action, are things for which the patient deserves
pity, scarcely blame, for he knows their existence, and feels the
torment of their mastery over him. That dominion may increase
until moral or inlelleciual insanity is established — a result not un-
frequent, when, misled by the clean tongue of nervous dyspepsia,
to which insanity of this kind belongs, the practitioner has only
debility in his head, and prescribes stimulation as a remedy.
Such cases people the lunatic asylums.

But when the white matter of the brain is principally affected
by morbid sympathy with the stomach, we have, for the most
part, mental phenomena indicating oppression of the mind's phy-
sical requisite. There is slowness of perception, thought, and
action ; everything is troublesome or impossible ; attention flags ;
reading and talking are alike irksome ; reverie takes possession
of the patient, and somnolence often steals on him. Besides
these mental symptoms, there is more or less giddiness, confu-
sion, sense of weakness of the brain, expanding sensation of the
skull, numbness of the scalp, intense aching, or simply malaise
of the whole head. The external senses also suffer; humming
and other noises pervade the ear, and deafness invades it ; the
vision is disturbed by black spots, dark crape, steaming vapors,
sparks and flashes of red ; the taste is obliterated, or is pervaded
by acid, saline, mawkish, putrid, or metallic savors ; and the
smell, though the least liable to distortion, is sometimes crossed
by disagreeable, and occasionally agreeable, effluvia, which do

KtJCOITS AND NEEl;*US INDIGESTIOH . 7©

Obi exist in the atmosphere. These perversions of the external
senses are rather referable to the disorder of the spinal con},
whence the nerves of those senses arise, than to the brain itself.
But besides that they arise from the cord within the skull, the
congested state of the brain suffices to explain the deterioration
both of the sensual and mental operations. For when, in conse*
quence of long continued irritation from the stomach, the brain
becomes the recipient and the retainer of an undue quantity of
blood, its distended blood-vessels press upon all the nervous mat*
ter contained within the skull, white, grey, and spinal, and in
this manner interfere with the activity of each and all. Pressing
upwaris and laterally, the distension affects the^ey matter, the
physical organ of the mind's activity ; hence the slowness of
perception and thought. Pressing on the mass of white matter
itself, and downwards, upon the upper portion of the spinal cord,
whence the nerves of the senses originate, the deficient volition,
the irresolution, and the perverted or deficient external senses,
are readily accounted for. And such pressure may go on to
apoplectic suspension of all the faculties, sensific, perceptive,
thinking, and moving, or tell only on some one, causing deficient
memory on particular subjects, palsy of some particular limb or
set of muscles, or annihilation of some sense, as of vision in
amaurosis.

Fulness of the white portion of the brain may be either of a
character to induce sudden apoplectic seizure^ or gradually to sap
the integrity of the functions, and cause slowly-coming imbecility
and paUy, The different conditions of circulation in the head,
leading to such terminations, will be stated when speaking of
these two maladies. Meantime it should be mentioned that mu-
cous indigestion is the most commci originator of the fulness in
question.

In speaking of these nervous phenomena of chronic indigestion,
and of their production from disordered circulation of blood
in the great centres of the animal nervous system, we are never
to forget, that such circulation is carried on under the control of
the ganglionic nervous matter distributed in those centres. The
brain, in fact, may be regarded as one large ganglion. The
most minute change in the sensific, motific, or mental acts, is ac-
. companied by a corresponding change in the circulation, and
therefore in the ganglionic influence. Looking back to the start >
ing point of the whole of the symptoms, the digestive organs, the

80 MUCOUS AND NERVOUS INDIGESTIOZr.

great centre of the influence alluded to, we cannot fail to remark
the importance of keeping in view the physiological fact to which
I have called attention. It has the strongest hearing on the treat-
ment, since, in the regulation of the mental and bodily exercise,
we are reminded of the mode of connection between the brain,
which is to perform it, and the stomach, which is to keenly feel
what goes on in the brain. Moreover, this feeling is an organic
one ; it is one dependent on the organic, the ganglionic commu-
nity of nerves between the two points, the stomach and brain ; it
is one which may exist to the degree of the most intense disease
without eliciting any animal feeling whatever, and which, there-
fore, is only explicable on the ground of the ganglionic connec-
tion. Ulceration of the stomach may exist without an animal
sensation ; and not a pain, ache, or any other feeling, may pre-
cede an apoplectic seizure.

The symptoms of chronic indigestion which refer to the skin,
are those denoting irregular and deficient circulation in it. The
sensations of the outer surface show this in the great suscepti-
bility to cold, the incapability of reacting against the elements.
Dyspeptics are always more or less " coddles," and that instinct-
ively, for let a breath of 40° of Fahrenheit blow on the skin< the
little blood that is in it leaves it, and the internal orgaiis, already
congested, receive it without the power of returning it ; and the
consequence is, increased irritation of the spinal cord, and shiver-
ing, and a feeling of misery transmitted from the skin to the
same point, and to the brain. In this manner it is that cold so
often begets intense headache in dyspeptics, and occasionally even
apoplectic pressure on the brain : winter is well known to be the
season for frequent apoplexies. Creeping sensations^ and those
of pricking, are referable to the same irregular circulation in the
spinal cord and the skin, and in both it is induced by the tempo-
rary increase of irritation of the digestive organs. Flushes of
heat and of redness acknowledge the same cause ; the power of
controlling the equilibrium of the circulation is partially lost by
the disorder at the ganglionic centre, the stomach, and the blood
is urged hither and thither, according to the phase of irritation
existing within. Most commonly, however, these flushes are in
the face and head, those parts receiving more blood in health,
and sympathizing more directly in disease, than other parts, with
the digestive apparatus. Stagnation of blood in spots also
takes place, and pimples then appear, chiefly in the face also

XUCOXrS AND KBRVOUS INDIGBSTION. 81

and for the reason given in the last sentence. Symptoms of this
kind are most common in nervous dyspepsia.

Yet these irregular distributions of blood on the surface are
rude but laudable efforts of the internal organs to throw their
disorder on the less important organ — ^the skin ; and as long as
they continue, the patient may be said to have an amount of vis
vUcB in him sufficient to act upon in treatment. In such cases
there always remains sufficient blood in the skin to invest it with
some of the color, softness, and elasticity appertaining to life ; it
looks like the covering of a living frame. But in many cases of
chronic dyspepsia the internal mischief has existed so long, or
has been of such a destructive character, that the skin has lost
all its vitality, and is like, in appearance as well as in activity, a
surface of parchment. It does not feel or Took- as if it were
alive ; its reactive agency is suspended, and, except for cold, it
has but little sensation ; there is very deficient circulation in it.
At other times, the skin, though dirty-looking and without a shade
of healthy hue, is nevertheless possessed of the elastic feel of
life. This state is oflen present as the result of purging with
vegetable aperients, colocynth, aloes, &c., and implies a vitiation,
a deterioration of the blood, that deprives it of its healthy scarlet
hue, and endues it with the unnatural shade of which the skin
partakes, which is not so much deficient in blood as supplied with
bad blood. A corroboration of this I have seen in many instan-
ces where, in female patients, as the skin became more clear and
ruddy, the periodical illness, which had been, in the outset, of a
dark unhealthy color, passed into the vermilion, which speaks
for a more wholesome condition of the blood. This state of skin,
therefore, is more to be relied upon than the dead condition last
described, which is more ordinarily the result of great abuse of
the nervous system in excesses of the passions, and of prepara-
tions of mercury and iodine. For the rest, the irregular distri-
bution of blood to the skin, as shown in heats, flushes, pimples,
eruptions, dec, is more frequent in the nervous form of dyspep-
sia ; the deficiency of blood on the surface, as shown in the in-
active, parchment skin, is more frequent in long continued
mucous indigestion ; and as the muddy, yet lively skin, indica-
tive of vitiated blood, is a sort of passage towards the dead skin,
so. is it to be found in certain phases of the nervous, as well aa
the mucous dyspepsia.

In this exposition of the symptoms whoso aggregation const!
5*

1^ XUCOUS AND NEKTOnS UIDiGISTlON.

tutes indigestion, I have confined myself to such as maj $Am
from disorder of the stomach and its nerves alone. Others there
are which, though very often seen accompanying the above, are
by no means essentials of dyspepsia ; I allude to disordered se-
cretions of the liver, kidneys, and bowels, as also of the genital
organs. Of these I shall have occasion to speak hereafter. But
even of those which I have enumerated, let it be understood that
only a portion can be present in the same individual, according
to constitutional predispositions, and the phase of stomach irrita-
tion that obtains. In some the dyspepsia originates head symp-
toms, in T}onsequence of the large and active development of the
nervous system ; m others of scrofulous habit and contracted
chest, the stomach is the author of chronic inflammation of the
air tubes, cough of various kinds, ^c. ; whilst in others, again,
skin disease is the chief evidence of stomach disease. The same
applies to the symptoms in the organ itself 5 they may be few or
many, so far as the sensation is concerned, according to the or-
ganic connection between it and the brain. But in diseased
sensations, secretions, and movements, there is always a sufficient
number of symptoms to determine the existence of indigestion,
mucous or nervous.

Which of these kinds of disorder it is, may be in a great mea-
sure ascertained by reference to the above detail of signs, where
I have marked the head under which each symptom comes. But
it may be profitable to place the distinction in a more concentrat-
ed form under the eye of the reader ; the rather as it has an
important bearing on the treatment of each.

Around and especially underneath the stomach there is a
thickly-meshed network of nerves of organic life {see frotUispiece
engraving), from which, after infinite subdivisions, myriads of
twigs proceed into the substance of the stomach and endue its
inner or mucous membrane with organic sensibility and secre-
torial power. Intertwined with this network are ncr\es from the
spinal cord and brain, whose office is supposed to be the convey-
ance of sympathy and animal sensation to and from those organs
and the stomach : the quantity of theso nerves of communication
varies in individuals. Now, by nervous indigestion I mean those
symptoms which indicate irritation of the nervous nc*iwork about
the stomach ; and by mucous indigestion those which point at the
lining membrane of the stomach as the seat of the mischief.
Such a distinction unquestionably exists and influences the treiit*

MUCOUS AND NE&VOUS INDI6BSTI0N. 89

went and the lesult ; but, as may be readily conceived, where
in one case the roots of the nerves, in the other the extremities,
are points of disorder, one ofttimes runs into the other, and each,
at all times more or less affects the other, the nervous irritation
occasionally disordering the mucous surface, and the latter, when
exasperated, involving the whole plexus of nerves, and by the
junction exciting a most formidable species of dyspepsia. Such
is the organic distinction ; the functional one will be best express-
ed in the following parallel table.

XERVOUS DYSPEPSIA,

Occurs in persons of vivid nervous
system ; large heads and active hab-
its; in women and youth.

. MTTCOUS DYBPKPBIA,

Occurs in persons of slow animal
sensations, medium heads, steady
minds ; in middle age.

The result of mental shocks, tense
condition of thought, excesses of the
passions, mercury, iodine, opium,
bitter tonics, sal volatile, &c. Also
follows on nervous fevers treated
, badly, and bn bloodletting.

In its course is accompanied with
more animal pain, s{)asms, eructa-
-tioBs, flatulence, sinking, gnawing,
great and frequent, but often capri-
cious appetite, distress after eating,
slight tnirst, bowels irre^lar, faeces
sometimes bilious, sometimes other-
wise.

The result of sedentary habits, study,
excesses of diet, especially eatings
saline purgatives, arsenic, and other
mineral tonics.

In its course begets scarcely any
animal sensations, is accompanied
by little flatulence, much rising of
food, deficient appetite, great thirst,
bowels torpid, evacuatioos white.

The tongue generally red, clean, and
swollen, or covered with a white,
silvery mucus, the lips and ^ums red
and swollen, eyelids red, skin flush-
ed in places, subject to eruptions
and pimples, flesh emaciated and
toiry.

Refltlessness of mind and body, im-
patience, irascibility, pain, and
giddiness, and weakness of head.
Produces atonic congestion of head
and gradual palsy. Causes palpi-
tation of heart, stomach cough, and
even tubercular deposit in lungs.
The liver only irregularly and for a
time involved. Fulse generally
quick and sharp.

Tongue flabby, covered with color-
ed fur, red edges and points appear-
ing at the sides and centre of it, lips
marbled or like yellowish wax, eye-
lids the same, skin like parchment,
body turgid with unhealthy fat.

Tendency to somnolency and inac-
tivity of body, irresolution and de-
pression of spirits ; dull pain with
confusion of head. Produces apo-
plectic seizure and sudden palsy.
Excites but little morbid sympa-
thies in the chest, but is generally
allied with considerable disorder of
the liver. Pulse generally dull-
hard, and comparatively slow.

•These will suffice to mark the pathological differences between
the two states of dyspepsia ; although there are other toon

64 MUCOUS iCND N£KV'}US INDIQBSTIOV.

minute signs which make the line of demarcation still more pro
oounced. They are important, inasmuch as they indicate, on
the side of nervotts dyspepsia, excessive, irregular functions with
mal-distribution of blood ; whilst, on the part of mucous dyspepsia,
the phenomena point to oppressed function with stagnation and
congestion of blood in important organs : considerations which
must necessarily have much influence on the treatment.

To this TREATMENT OF INDIGESTION we at length arrive ; in
which we have to refer, as might be expected, to the nervous or
mucous character of the disease. Not that [ would have those
epithets treated, which mean nothing save as they are represen-
tatives of states of vitality; these are what we have to deal with.
Accordingly, if with mucous disorder there be some of the signs oi
nervous irritation, such as the sharp pulse and clean red tongue,
as sometimes happens, this evidence of the irritation in question is
to be met by appropriate measures, notwithstanding the prevail-
ing character of the disorder," Such a complication, though not
unfrequent, is generally temporary, and is traceable for the most
part to some passing mental agitation. So also the addition of
mucous is often, indeed more frequently, made to nervous irrita-
tion, and by repetition at length involves the lining membrane of
the stomach in permanent disorder. In such case there is a Mrd
state of digestive derangement to treat.

The TREATMENT Of NERVOUS DYSPEPSIA has in vicw the reduc-
tion of a purely nervous irritation— of a chronic inflammation of
the nerves of the stomach. These last are exquisitely sensi-
tive ; and as all excitements applied to any part of the body are
re-echoed, as it were, at this centre of all nutrition, it behoves
to be very careful as to the means applied. As regards the
stomach itself, therefore, the remedies should be chiefly negative
— the withdrawal of irritating food and beverage^ And this kind
of indigestion is more exasperated by the hulk of food than by the
highly nutritious character of it : hence the moderate use of ani-
mal diet is more agreeable to the stomach than the larger quan-
tity of vegetable food that would be required for the good appe-
tite which usually attends this form of the disease. A smaller
bulk of animal food suffices for nutriment, and does not distress
the stomach so much j besides which, the irregular and deficient
ganglionic nervous power causes a bad analysis of the vegetable
diet, which, instead of being converted into healthy chyme, has its
gaseous elements let loose \ and these «id much, but do not standi

TREATMENT OP KBKV0X7S INDIGESTION. 85

time in producing the flatulent distension so distressingly proini«
nent as a symptom. But it must not be supposed that concentrated
animal diet is hereby laid down as the invariable rule of diet. Of
all the forms of indigestion the nervous requires the most accu-
rate adaptation of diet to the Protean changes of the functions —
changes which no writing could convey to the reader. In these
remarks I only pretend to give the leading indications of dietetic
management ; professional experience alone can detect the causes
for its daily or weekly alteration.

For a similar reason with that above .^iven — ^namely, the irri-
table and feeble state of the organic nerves of the stomach) liquids
of a high temperature are very prejudicial in nervous dyspepsia ;
although for the purpose of quieting some symptom, flatulence,
spasmodic pain, sinking or gnawing, recourse is usually had to
.he hottest tea or other vegetable infusion, sometimes to hot water
alone. This destructive practice invete rates the irritability of
the stomach, and relaxes its powers to such an extent, that many
patients coming to Malvern are utterly unable to take food with-
out hot water, and the introduction of the smallest quantity of
coH water brings on acute spasm of the stomach. Hence, it will
be found that the part of the water treatment which consists in
drinking cold water requires in many instances to be withheld
for a time, or to be very gradually applied, the patient taking
only a wineglassfull at one time ; and even this I have been
obliged to prescribe at a temperature not lower than 55^. In
proportion as the positive remedies produce a sedative effect on
the stomach, the quantity of water may be increased and its tero«
perature decreased.

Those positive measures should have, for aim, the reduction of
local irritation by local remedies, and the establishment of a
counteracting irritative process in some organs distant from the
stomach.

The first of these is effected by fomentations with hot water
over the pit of the stomach, once or twice a day, from half an
hour to an hour and a half, according to the condition of the
pulse, a strong one justifying more fomentation than a weak one.
The temperature of the water varies with the intensity of the
symptoms ; the more acute the paij^ul ones, spasm, distension,
^c, the nearer to the boiling point should the water be. During
the fomentation the stomach ^ill bear cold water more patiently,
iodi accordingly, it should be then given in frequ€»t sips. Ii

66 TEBATBfENT OF NBRVOVS IND16B8T10N.

the intervals between the fomentations, a compress should be
worn on the stomach, wrung out of warm or cold water, accord-
ing to circumstances.* Where the animal heat suffices, the com-
•)ress should be cold, and frequently wrung afresh.

Another aim, the establishment of a counteracting iriitative
process in some organ distant from the stomach, is compassed by
wet-sheet packing, rubbing with the dripping sheet, long sit2
baths, and foot baths ; the two former inducing the blood towards
the skin, the sitz baths deriving towards the lower organs of di*
gestion from the upper, and the foot baths acting in a more tran-
sitory way as derivatives and stimulants to the abdominal con-
gestion. And it should be kept in mind, that the object is to
produce a counteraction, resembling as nearly as possible in its
character thut which it is intended to remove— namely, a nervous
irrftation. For instance, it is not desired to produce a suppura-
tive congestion of the skin, — such as would generate boils, — but
that amount of cutaneous irritation which is exhibited in a rash
or itchy eruption. A good deal of friction is therefore desirable,
and thence the use of the dripping-sheet is mostly preferable to
the shallow bath, the rather if the patient is much shattered.
Nor should it be employed after the packing-sheet only, but the
skin should be excited by it alone, once or twice a day, besides,
it being peculiarly grateful in its ""results to nervous dyspeptics.
The long sitz baths, besides drawing blood towards the lower
bowels, and creating an irritation there, also excite the nervous
irritation of the skin of the loins, the itching of which very often
makes the patient forget all his sensations about the stomach.
The foot baths, besides being derivative, afibrd, by the combined
cold and friction, an amount of nervous stimulation to the centre
of nutrition, which tends to dissipate the congestion of its nerves ;
and thus it is that this simple remedy so often brings instant
relief to malaise^ or pain of stomach or head.

But it is in the employment of the wet-sheet packing that the
greatest discrimination is required in this nervous malady. Al-
though, in the great majority of cases, it is necessary, yet does
its prolonged use appear to aggravate many of the brain symp-
toms of the disease, the patient becoming more fidgety, hypochon-
driacal, sleepless, and tremulous. It is true, that irritation can-

* To prevent repetition, the circumstances requiring a difference in the
details of treatment will 1)6 stated in the third part, which treats of such
ietailsL The rationale of them will also fall into that part

TRSATNENT OF NBBVOUS INOIGBSTIONt 67

not be suixlued without lowering the energy of the brain ; but
this may be done in a nx>re gradual and less painful way, by
moderating the use of the sheet; packing, for instance, only
every other day, and using more of the dripping sheet. But
should the signs of its trying the frame too much come on, there
only remains to desist from it altogether for a few days or a week,
to take more frequent foot-baths, and to diminish the amount of
exercise. Indeed, as regards all the positive means recommend-
ed, the practitioner will find it necessary, from time to time, to
vary the application, suspending some and augmenting others, to
meet the endless vagaries of a nervously morbid stomach.

A very nice part of treatment to adjust is the amount of ea;er-
ewe. In the majority of cases, it should be very sparingly used,
because in exercise there is an exertion of the seat of the will,
the brain, and spinal cord, which are already kept in an irritated
state by the digestive disorder, and whose excitement in the act
of locomotion is, by the strong sympathy between the parts, pre-
judicial to the nerves of the stomach ; it, in fact, sends new irri-
tation to a set of nerves already oppressed with a morbid amount
of it. These cases require all the acumen of the practitioner ;
for on the question of exercise hinges that of the amount of
water treatment, much of the latter demanding more of the former,
and vice versa. Nor should he be led away by the locomotive
energy of the patient, for that is for the most part fictitious, and
depends on the unnatural excitement of the brain and spinal cord,
urged in their office by the unnatural irritations propagated
towards them by the digestive nerves. Patients in this state
have, in fact, impulse, not sustained energy. They talk, walk,
and eat rapidly, but each has the efiect of thickening the spittle,
drying the tongue, and rendering the pulse sharp, hard, and
rapid. Neither does exercise increase appetite in them ; it rather
annihilates it.

The rule to determine the amount and kind of exercise in
nervous dyspepsia is to watch the efiect of walking on the visce-
ra. If it produces any of the following symptoms, sinking or
dragging at the pit of the stomach, nausea, loss of appetite, thirst,
dryness of mouth, fistid breath, hard, edged pulse, and shrunk
countenance, it will not advance the disease towards cure, but
rather exasperate the nervous congestion at the pit of the stomach ;
for it cannot be too often repeated, the digesUve organs pay far
ike rest of the body ; exert what part soever you may^ ihey have

88 TEBATBfBNT OP NERVOUS INDIGESTION.

to find the materials for the exertion. Now, nervous indigestion
very rarely bears exertion of the limbs, without some of the above
signs of its disagreement ; and it is, therefore, generally advisa*
ble to refrain from much walking, and to have recourse to driving,
or, if the weather permits, to sitting in the air, for that is always
necessary. Above all, the patient should refrain from exertion
immediately before a meal, and should remain seated for at least
a quarter of an hour previous to eating. Similar reasons forbid
the wasting act of talking, as well as the close application of the
mind to any one subject, whether it be abstruse or superficial.
This, indeed, ranks among the frequent causes of nervous dys-
pepsia.

Sleep is very uncertain in the disease, and therefore should, in
my opinion, be caught whenever it can, in day or night, even
after a meal, if the brain tends towards it. The stomach gains
thereby so much absence of excitement from the waking brain,
which also is recruited. I constantly recommend it to patients,
and never found any but agreeable consequences from it. Tor-
ment is cheated of the time spent in sleep. But, except in the
extreme cases where the brain and spinal cord are seriously com-
promised, and tremors, giddiness, and faintings prevail, early
hours of rising should be observed, nor sliould breakfast be taken
in bed.

The clothing of nervous dyspeptics must vary with the weather,
until the internal irritation has been subdued to the extent of al-
lowing of better sleep, fewer morbid sensations at the pit of the
stomach, and more exercise. Cold damp is the most intolerable
to them ; the east wind is, also, their misery ; and at periods
when either of these is likely to prevail, silk or some fine woollen
texture should be worn next the skin. It must be remembered,
that they have a congestion and feebleness of reaction in the in-
ternal organs, and that when external cold is applied continuously,
as the atmosphere is, blood is driven in upon those organs, they
not possessing the organic energy to react and drive it outwardly
again. Dry friction with hair gloves or rough towels is beneficial,
and may be practised either after the baths or at any other time.
It is well adapted for the feet, when, after a foot-bath, walking is
found to be impracticable.

After these outlines of the treatment of nervous indigestion, I
proceed to illustrate both it and the ordinary symptoms of tht
disease by a case treated by me at Malvern.

TEEATMSNT OF NERVOUS INDIGBSTtOir. W

Case L— Neevous iNBioESTioir.

In the eprixig of 1843, a gentleman came to me complaining of in*
ceseant sensations of various kinds in the pit of the stomach, gnawing,
sinking, &c., hut of no actual pain. Pressure there caused no pain, but
almost made him faint. He mistook, as all the world does, these sensa*
tions for hunger, and was chewing biscuit all the day long, under whic)i
diet they flourished and increased. His appetite was good, as any one
ivould have allowed who saw him eat his ordinary meals as ho did, with
amazing rapidity. But after its gratification came distress, distension of
stomach, flushing of the face, restlessness, &c., &.C., and continued for
two or three hours. He had a clean, red, tongue, swollen and deeply
split in all directions, a chronic irritation of the tonsils, gums that were
receding from the teeth, and breath hot but not foetid. Bowels irregular
as to time and quality, but, on the whole, rather constipated. The pulse
was sharp and rapid. The heart often palpitated. He slept exceedingly
badly, his thoughts being rendered most vivid and painful by the vigils.
He had humming in the ears, and occasional slight obscuration of vision.
Flying pains, stitches and cramps in the ribs, between the shoulder
blades, about the hips and in the fingers, teased him, and gave him no-
tions of rheumatism, scarcely believing that with such an appetite he
could have dyspepsia ! His mind was on the whole irritable, but he had
sometimes fits of depression of several hours' duration, in which he made
no complaint of sensations in the stomach. He could not apply his mind
long to any one subject, but that was more from restlessness than ina-
bility. He could walk any distance, but loss of appetite, sinking of the
stomach, and shrunken face, were the consequences. The feet were
constantly cold, and the skin, highly sensitive to cold, often took on the
state called " goose skin." It had, however, too much color about the
head and face. He had been suffering for more than five years, and not-
withstanding his appetite, had become thinner and softer in flesh. He
had all the active habits of a mercantile man, and it was the long, un-
ceasing anxieties of his avocation which gradually sapped his digestive
powers. Of course he had taken all the aperients, tonics, alteratives,
&c., that could be devised.

What I did to this patient was as follows : — ^I had him fomented for
three-quarters of an hour every night with water at about 150^. On
rising, he was well rubbed with the cold dripping sheet, the same, at noon
and five p. m. He drank a small tumbler of water in sips, whilst dress-
ing in the morning, another in like manner after the noonday rubbing,
again about two hours after dinner, taken at two f. m., and one between
tea-time and bed-time. He wore a cold wrung compress on the bowels
all day, and wrung it afresh after each rubbing. He walked half an hour
after each dripping sheet. Cold water, cold toast, and a very little but-
ter, for break^ist. About five ounces of well-done meat, and some stale
bread, and salt, for dinner; and the same food as at bceakfisust &r half

J

OT TESATMBNT OF NERVOUS INDIOSSTIOlff.

past idz P. H. After four days of this, he waa packed in the half w«ti
sheet every morning, and rubbed with the dripping Sheet after it AL
the rest as before. In the course of three weeks, he began to feel weaker,
but more quiet in himself. His sleep had improved, also. He then dis- "
continued the fomentations, and took a sitz bath at 60° for twenty minutes'
at noon, in place of the dripping sheet. I ordered him more water, espe-
cially before breakfast. The bowels had become more constipated than
beforo, but although opening very slightly, only every three or four days,
no sign of fever appeared. Two weeks of the sitz bath, which had,'
meantime, been taken twice a day, made impression on the bowels, which
gradually became more free, with a previous degree of flatulence that
was astounding. In the seventh week, he was considerably relaxed in
his locomotive powers, and much preferred rest to movement. But with
all this apparent loss of strength, he was actually, organically, stronger ;
his pulse was rounder and soft, and he had no sinking at the stomach.
He now left off the morning packing, and took only a cold shallow bath
then, the two sitz baths, cold, in the course of the day, for thirty minutes
each, and two foot-baths of ten minutes each. Under this regime, he
began to regain his alacrity in eight or ten days, when he was suddenly
seized with giddiness, nausea, and tremblings, which in the course of
eighteen hours terminated in a copious diarrhoea. This continued for
four days with varied intensity, the appetite remaining good all the time,,
and the nervous system quiet. This irUemal crisis took away some of
the more distressing symptoms, tlie flushing of the face, the palpitation,
the cramps about the hips, and it increased the warmth of tiie feet.
During its continuance, the patient ceased to take tlie sitz baths, but
made no other change in this treatment. During the previous fortnight,
also, I had improved his diet by a greater quantity of animal food, and
simultaneously with that had increased the amount of exercise. Every
now and then there would appear some sharpness of the pulse and heat
of throat, against which I employed a single wet-sheet packing, which
never failed to reduce tlie reviving irritation.

Circumstances obliged this patient to leave Malvern in the eleventh
week of his sojourn. He left it with this gain — ^better sleep, quieter
nerves when awake, spasmodic sensations of the stomach and limbs gone,
bowels regular, pulse larger, breathing deeper and longer, palpitations
gone, flesh firmer and fuller. But he was still far from well, for his sto-
mach was very touchy ; under the greatest care of his food, there still
remained some feeling of distension and signs of flatulence after it, and
then, too, he did not feel so quiet as he had done before the meal. How-
ever, I gave him full directions how to proceed, desiring him to pack
once a week, take the cold shallow bath for two minutes every morning,
a cold sitz bath for half an hour once daily, to wear the stomach com-
press, and to drink six tumblers of water daily. He continued this plan,
as well as a stringent diet I prescribed, for four or five months aftei
quitting Malvern, corresponding with me meanwhile, and at length

TBEATKBirr OF MUCOUS INDIOBSTrON. M

gained his end in the Teatoradon of a stomach and nerves which wen
conducting him, V^ith unerring certainty, to the dangers of hrain ccmI"
gestion and palsy, or to the horrors of hypochondriasis.

Cases of the above kind are very common in persons of
business, and of active and anxious minds — ^a lai^e class ir.
English society. The usual mode of treatment is to add fuel to
thjB fire at the stomach,. in the shape of tonic and alterative medica-
tion and stimulating diet. Yet it is not the less true that .the
patient must be made apparently weaker in order to be made
dbsohUely stronger. That irritation of the stomach nerves which
disorders the brain, now causing violent impulsive and fictitious
energy, and again tremblings, must be reduced, and this done, the
brain loses its old irritant, and returns to what it really is, a very
weak, disabled brain, sending a very small amount of sustained
energy to the limbs. This lowering part of the process is effected
by the fomentations, wet-sheet packing, and diet, which, while
they seem to enfeeble the brain, relieve the viscera from oppression,
and enable them to act more forcibly and healthily. Hence my
saying that the patient is " absolutely stronger," though " appa.
rently weaker ;" real strength is to be found in the healthy viscera .
alone.

The building up in such a case as the above is a very nice
process, so small is the irritation that is capable of arousing the
old mischief again. With all the care possible, some of it will
return, as the reader observes, in the necessity for occasional wet-'
sheet packing far on in the treatment. The tonic effects of the
water-cure require to be tempered ever and anon by its anti-
phlogistic parts, when it has to deal with such a malady as nervous
dyspepsia, and this is one reason wherefore so much time is re-
quired to overcome it. And it is the great reason wherefore the
ordinary medication and diet fail to overcome it at all ; their
effects are wholly irritating. For the rest, six months is a
sufficiently short period to conquer so slippery an antagonist as a
morbidly nervous stomach, which has generally endured for more
than as many years, and I will caution the reader against recorded
cases of the disease cured in fivaor six weeks. Such cases never
have occurred, and never will occur, save in the advertisements
and pamphlets of charlatan writers*

I now pass on to the Treatment op Mucous Dyspepsu. At
AD early 8tage» not lo9g afjter it has deserved the epithet " chronio/*

92 TREATMENT OF 1SVCG09 INmOBSTIOK.

the disease is best managed by moderate wet-sheet packing-— thAt
is, every other morning ; the cold shallow bath every morning ;
sitting baths of half an hour twice a day, with friction of the
abdomen during the last ten minutes of each; and abundant
drinking of water. But the practitioner of the water-cure must
not expect such easy cases. He will find^tbose only seek his aid
who have had the simple acute indigestion exasperated by bad
treatment and by continued excesses, until the former has ceased
from sheer exhaustion of the means, and the latter from the sheer
impossibility of committing any more, the jaded stomach revolting
against everything offered to it. In the great majority of the
cases which I have seen here, the gastric mucous mentbrane gave
evidence by the tongue of utter loss of tone, with great perversion
and sometimes suppression of the mucous secretion. The want
of appetite and the deficiency of biliary and fbcal secretions also
pointed to the oppressed and obstructed function of the digestive
nerves generally. Nor do the brain phenomena lead to any other
conclusion, for there we behold depression and stupor of mind,
irresolution and loss of volition, dull, heavy pain, and dulled
senses. The skin, too, partakes of the same inactivity, and is
'bloodless, harsh, inelastic, and altogether obstructed in its per-
spiratory office. In addition to all which, it will be found that
the patient is of rather a slow than a vivid temperament of body,
has a slow pulse, slow movements, and but a small degree of
mental vivacity.

Taking these facts into consideration, the indications of cure
are, to remove obstruction of function, and to give tone. Before
prescribing, with a view to the former, it is necessary to ascertain
well whether there be no lingering of active irritation in the diges-
tive organs, or no commixture of nervous disorder with the mucous. .
Reference to the subject of nervous dyspepsia will show how this
is to be ascertained. If such is found to be the case, it forms a
third indication, and the Jirst to be attended to. This is done by
the daily use of the wet-sheet packing, and, perhaps, of nightly
fomentation too. When by these means the pulse I as lost all
sharpness, and pain and gnawing of the pit of the stomach, dec,
are reduced, we proceed to remove the obstruction to the function
of the mucous membrane. This is done by rousing the outer
mucous membrane, the skin, to re-assume its office by bringing
to it a quantity of blood— of blood whose excess is oppressing the
office of the internal mucous membrane. The sweating procesf

TBSATICBIfT OF MUCOUS INDIGESTION. M

B ooe of the means en^loyed for this purpose, with the odhi
shallow bath for three or four minutes after it, so as to produce a
vehement revulsion to the skin. Sweating should be used every-
day or every second day, according to the effects of pain or palpita-
tion it produces in the head and heart, and it may be done either
before breakfast or a couple of hours afler it. As the object is not
to lose a quantity of perspiratory fluid, but to draw blood to the sur-
face, the patient may go into the cold bath when the moisture has
been on the skin eight or ten minutes. Twice in the day he
should take a cold sitz bath for thirty minutes. And after the
bowels have been brought into action, the douche may take the
place of one of the sitz baths. At this point, also, the sweating
may*be relaxed for a period. But as the effect of the sweating
and douching is to rouse the system to extraordinary efforts, it may
be well now and then to take a wet-sheet packing, in order to
obviate the generation of constitutional irritation, into which those
ef^rts may run. To further them, the patient, during the above
treatment, should drink water copiously — ^that is, from seven to
ten tumblers daily, by which he both quickens the chemico-vitd
changes of the body, and dilutes the morbid secretions of a diseased
membrane. Indeed, water-drinking is a very important part of
the treatment of mucous dyspepsia, in which the mass of the
blood is always more or less diseased, as a consequence of bad
gastric juice and imperfect digestion, not to mention the drugs
that have been absorbed into it during years, and taint its
current.

Meantime, this copious water-drinking and these long sitz
baths demand a good amount of exercise to promote the absorp.
tion of the one, and to produce reaction afler the latter. And in
this form of dyspepsia walking should be practised for an hour or
more before each meaV and may be beneficially varied by horse
exercise. Sedentary, silent, and idle practices are most preju.
dicial here. Even in the house, the mind of the patient should
be occupied with conversation, games that interest without
stretching the attention, and books of fancy rather than philoso-
phy.

The diet must be regulated Jby the amount of appetite, espe-
cially at the outset of the treatment, when it is, for the most part,
very deficient, and is even replaced by loathing of food. It would
be absurd, in such case, to put strong food, or much of any kind
of aliment into the stomach, when there is neither muscular

'04 TBEATXSNT OF XITCOUS INmOBSnOK.

moTement enough to aid in, nor healthy gastric juice to effect, its
digestion. It is better to withdraw animal food for a time, and
give the patient farinaceous and milk diet, for milk generally
agrees in mucous, but seldom in nervous indigestion. The same
objection to hot liquids which obtains in nervous, applies to mu*
cous irritation of the stomach, though liquids generally are m(»B
admissible here than in the former instance. But as this implies a
low d^ree of nutrition, so, while such diet is in use, modification
must be made in the rule for exercise j ust propounded . During the
first week or two of treatment, small diet and short exercise must go
tc^ether. At the end of that time, the appetite very rarely fails
to appear ; and then is the period to make a gradual improvement
of the quality of the food, giving while meat every other *day,
then red meat in the same manner, and by degrees, as more ex-
ercise, more air, and more water treatment are quickening the
waste and inducing appetite, allowing meat once daily, and aug*
menting the quantity of it. Details of these general directions
must be regulated by the practitioner according to the fluctuating
vitality of the patient ; he is a very coarse manager of disease
who gives a diet table, and leaves the patient to it through all the
varying circumstances of a bodily frame under potent medical
treatment — ^treatment which is daily and hourly effecting changes
in that frame. But in any case, the quantity of food should be
kept under, particularly as in raucous dyspepsia the sympathy
with the brain is great, and the circulation of blood there tending
to fiilness. In fact, chronic mucous dyspepsia is the great parent
of apoplexy.

When stronger food and more exercise are taken, the clothing
should be decreased, and flannel underclothes dispensed with. In
a few cases, cotton drawers and waistcoats may take the place
of flannel, if it be the winter : but if waiipi weather is expected,
it is better to give up both. This lifeless skin must receive all
the stimulus which air as well as water can afllbrd to it, and it
must be made to perform its full share of the functional changes -
which constitute life, and which, in this kind of dyspepsia, are
almost wholly performed by the wearied and congested internal
skin, the delicate and highly sympathizing mucous membrane of
the stomach.

The following case is in exemplificaticm of what precedes :

tREATHBNt OF MOCOUST INmCESTIOH. !Ml

CASE II. — ^Sfucotrs Indigestion.

A gentleman, thirty-nine years of age, after masking acute attacks of
indigestion for years by the usual means of a mercurial and a purgative;
and indulging freely, meanwhile, in the causes of it, namely, good luncli-
eons and dinners, and bad hours, at last came to a stand still from sheer
loathing of food. The most potent condiments would sometimes enable
him to get down a small quantity of meat, or a larger quantity of scald-
ing soup : but spite of these and of innumerable tonics, vegetable and
mineral, he went from bad to worse, slept incessantly, but with horrid
dreams, was either listless or irritable, when awake, complained of dull
headache, thirst, and bad mouth, became corpulent in the body, puffy in
the face, emaciated in the limbs, and dirty-skinned all over. The kid-
neys acted little, the bowels less, and the skin not at all. No exercise,
no medicine could make him sweat, and he expressed his total disbelief
in my power to produce it. His pale gums, red and yellow tongue, and
almost bloodless lips, showed the stoppage of blood-making, and the con-
centration of what blood there was in the internal parts. As usual, he
had taken infinite mercury in different forms, and tonics of all kinds after
the establishment of the chronic disease, and it was the alarming effect
of one of these, iron, in the shape of chalybeate water, on the head,
which alarmed him, and induced .him to try (he water treatment as a
tonic without medicine. In fact, the tendency which this kind of dys-
pepsia has to cause apoplectic fulness, was fearfully aggravated by the
iron water ; which had been prescribed because the patient gave signs
of deficient blood — as if iron without digested food could supply it !

For the first five or six days I restricted the treatment of this patient
to rubbing with the cold dripping sheet, morning, noon, and evening,
one or two foot-baths daily, six or seven tumblers of water, the compress
on the bowels, about three hours' walking. I allowed him to eat what
he could, within the limits of plainly cooked fresh meat and fiau*inaceous
matter : but he got no hot or alcoholic liquid. My object was to accus*
tom his skin to the shocks of cold, and by the friction and exercise in-
duce some circulation and development of heat in it. When I thought
this was sufficiently attained, I had him packed with a damp towel in
front of the body every morning, followed by the dripping sheet : which
last was repeated as before in the day. As he warmed the towel well-, I
entered upon another phase of the treatment, the reduction of the inter-
nal hrritation. His food was made entirely farinaceous, and if there
was no appetite for that, he took none. As a consequence of this diet,
exercise was forbidden, except for a short space after each bath. He
now went on from the towel packing, to the partial, and then the entire
sheet packing, at first once, and then twice a day ; in which he gradu-
ally warmed more and more quickly. After three or four and twenty
days of this, his sensations were much improved : he had more elasticity
and less somnolence. His tooguei though more moists was even mora

M TftKATMBNT OF MUCOUS INOIQS8T10N.

fnmd than before ; but his appetite was improved, — ^not so his diet Aft
the end of the fourth week, however, this cheering prospect was over-
clouded ; frequently recurring nausea and bitter risings troubled him :
the water he drank rose into his mouth : he felt feeble, sometimes faint ;
yet his appetite remained through all this, not great, but better than for
many months before : tbe bowels were more obstinate than ever, and the
evacuations almost totally colorless. All this, told me that the process
of reducing the irritation had gone far enough, and that the digestive
organs were making an efS>rt to throw their mischief on some other or-
gans, which effort made the present tumult of sensations. Now, there-
fore, was the time to aid those efforts by the sweating process, — ^by
inducing a transfer to the skin. I therefore sweated him, aiid this was
ef^ted in three hours, notwithstanding his defiance to the contrary.
Three successive days of it seemed to free the liver from irritation, for
the bowels opened, and .bile began to appear in the evacuations. He
also took two sitz batlis daily, of half an hour each : wore the compress :
drank eight or ten tumblers of water. The appearance of bile induced
me to give him a small quantity of meat every other day ; and with this
augmentation of food, to augment the amount of exercise. This treat-
ment did very well for a week : at which time it seemed to tax the head
somewhat, wherefore the sweating was discontinued for two or three
days. Again, after its daily resumption for five or six days, the head
suflfered : and I therefore had him sweated and packed in the wet sheet
alternate days, the latter being intended to modify the exciting efiect of
the former. Under this plan he got on admirably ; the bowels acted
every second day ; the tongue cleaned gradually from the tip backwards
(an excellent sign — ^much better than when it suddenly cleans all over) ;
the strength improved, as did also the appetite, which was soon gratified
with a small quantity of meat daily ; coincident with which he wa^ told
to take as much walking exercise as he could. During all this time the
color of the skin had been steadily improving, whilst the bulk of the pa-
tient had been rapidly decreasing — in fact he had grown thin : he had
lost a quantity of pufiy, diseased fiesh, and was gaining some useful
muscle and healthy nervous matter. He was not, however, without bad
days, when nausea would prevail, and even end in bilious vomiting : but
this never lasted beyond the day, and was an indication of the continued
eflforts of the internal organs to rid. themselves of their irritation. Ner-
vous headache would sometimes occur too, which a foot bath took oflT.

So the patient went on until nine weeks had elapsed. I then allowed
his system to rest for a week, giving him only a shallow bath in the
morning. Three weeks after he had resumed it, and when the bowels
were in perfect order every day, he took the douche at noon, one sitz
bath of fifteen minutes in the afternoon, the cold shallow bath for three
or four minutes every morning, and the sweating only twice a week, the
wet-eheet packing being altogether discontinued. The object of this
lilaii was to produce the third, or tonic effect, after the reduction of irri*

nSATMSNT OF KUCOVS UfDlOSSTtOK. 07

tetion. In the fifteenth week of treatment, after a few hoars of maJaiae,
a small boil made its appearance in the fleshy part of the loins and grew
to a good sized one in four or five days, but with no constitutional dis-
turbance, though with a good deal of inconvenience in movement. Ap-
petite and all the functions went on well the whole time of this boi],
which suppurated, discharged, and after a fortnight dried up. Immedi-
ately after this the patient left me, and at his home only took the morn-
ing shallow bath, and five or six tumblers of water daily. Nevertheless
he had, from time to time during the following four months, a boil occur-
ring in difl^rent parts of the body, which teased him for a few days by
impeding some movement, but the inflammation of which was eflfectually
prevented from being excessive by the application of wet cloths to it.
Altogether this patient was under my immediate care eighteen weeks,
and the action of the treatment remained more or less for four months
afterwards : so that I look upon this case as under treatment for eight
months. He had been more than that number of years getting worse.

The above case presents a more complicated and a more seri-
ous state of disorder than the preceding one, and, in fact, mucous
dyspepsia is always a more dangerous malady than the nervous
form) which, however, is usually more tedious and requires more
nicety of treatment. In mucous indigestion there is first of all an
inflammation of the lining membrane of the stomach to subdue,
towards which fomentations and the* wet sheet are directed ; then
there is blood to be made to nourish the exhausted body, particularly
its extremities and skin, and the appetite, which grows as the in-
flammation diminishes, efiects this, aided by the copious taking
of cold water ; and lastly, but simultaneously with the formation
of blood, there is the necessity for directing it towards the exterior,
80 as to prevent its congestion in the very internal organs which
it is the aim to relieve, and this the sweating and douche tend to
efifect. So that it will be seen how complicated the indications
of treatment are in such cases, and how much patience^ both on
the part of the patient and physician, is necessary for cure. You
may give fictitious, temporary appetite, by bitters, &c.; you may
send blood to the surface for a period with various stimulants, but
you can neither maintain appetite until you have got rid of mu-
cous inflammation, nor keep blood on the surface until you have
made it, and directed it thither, and these two ends can only be
fulfilled by the hygienic means of the water treatment. But
another feature of these cases which requires much judgment to
detect and manage, is the tendency towards fulness of the hear),

6

98 TaSATMBKT OF MUCOUS INDIGESTION.

in proportion aa he finds the predominance of which, the physi.
clan niust relax his measures, the sweating more particularly.
The liver, too, is generally gorged, if not more deeply involved ;
but the sweating is most powerful in relieving that condition. Of
course, if there be signs of softening or any other organic change
of the brain, or permanent hardening, or enlargement of the liver,
the case is not one for treatment, except, in the latter event, for
mere palliation ; when the brain is organically affected, it is dan-
gerous to meddle with any treatment.

Nervous dyspepsia very often generates nnicous dyspepsia, just
as, in the chest, nervot^ asihmay by constantly irritating the lungs,
and bringing them into excessive and irregular play, gives rise to
inflammation of the air tubes and mucous or humid asthma. Even
whilst the nervous state alone predominates, the mucous lining
undergoes sudden changes of secretion indicative of very irregu-
lar circulation of blood in it \ and the occasional dryness, thirst,
and foulness of the mouth point to passing inflammatory conges-
tion in that membrane. Repeated through months or years, and
exasperated by indiscreet gratification of the appetite which gene-
rally attends nervous indigestion, this congestion becomes more>and
more permanent and intense, until a condition including the
symptoms of both kinds of indigestion is established, and renders
the life of the patient a scene of continual suffering. Into the
details of the signs of this combination it is unnecessary to enter
after what has been said of its two elements. Many dyspeptics
appear at Malvern with this miserable complication, which, from
the histories they give of themselves, is most commonly the result
of neglected diet and excessive medication — facts, for the most
part, connected, the medicine sweeping away the evils of the
feeding, and both plunging the stomach into more irremediable
disorder. However, there are varieties of intensity, and the ma-
jority can walk a>^out and occupy themselves in some way or
other. But the following is a case of the most extraordinary
character ; and the result is not a little extraordinary also. It is
one of the most striking illustrations of the power of the water
cure in stomach disorders, and the subject of it, who has taken up
her permanent residence at Malvern, is delighted at any opportii-
nity of testifying to others the resurrection of all her nutritive,
moving, and thinking powers, which she owes to that mode of
treatment.

COMBINATION OF NERVOtJS AND JIIUCOUS INDIfflEESZUni* M

^ 3. Combination of Neevous and Mtrcous Dtspbfsia.

Case IE.

In 1818, P. S , a member of the Society of Friends, who was thea

in her nineteenth year, after suffering many dyspeptic symptoms of a
minor kind, was attacked with vomiting of no ordinary character. It
was not a mere rejection of food, but a straining until the face and
tongue became purple. Neither was it an occurrence of any particular
part of the day ; it was at times nearly incessant, and at least five or
six times a day. She has been as long as eleven days continually with
a basin near to her head, so pressing and unceasing was the sickness,
during which time she took no food whatever. In this and in many
other attacks of similar intensity, she was under the necessity of taking
sustenance by injections of broth, &c., so utterly incapable was the
stomach of retaining anything. This state continued from 1818 to
1833. Throughout the whole of these fifteen years very few days pass-
ed without the sickness. On one occasion only, it failed to come on
for nine consecutive days, and on two or three other occasions she got
over five days without it. It was not so constant and bad in the first
year or two, but got very rapidly to its worst degree. The prostration
induced by this vomiting and incapability of retaining food obliged her
to remain in bed always ; day and night for fifteen long years she kepi
her bed — was never dressed during that time. All manner of medicines
were administered, but with no good result. All kinds of diet were
also tried to no purpose. * At first it was very low, and after a time this
was abandoned, and she was made to swallow meat three and four times
a day,^ith brandy, wine, &c. Her appetite was capricious.

At length, in the early part of 1833, the vomiting relaxed in degree
and continuance without any appreciable cause, and for six months she
was comparatively free from it. At the latter end of the year it re-
turned, and grew gradually worse, until it was as bad as ever, and con-
tinued so until July, 1843, when I first saw her. Of these last ten years
she was compelled to remain altogether in bed two years and a half,
the rest of the time was spent between the bed and the sofa ; she never
put her feet to the ground. During the whole of the above period, the
bowels had inclined to relaxation rather than constipation.

So far for the previous history of this extraordinary case, which I
have given in almost the very words in which she delivered it to me.
Being in Birmingham on professional business in July, 1843, 1 was re-
quested by one of my patients there to call on P. S , wlio, with

considerable hesitation, had agreed that I should do so. She had every
possible prejudice against the water treatment, had long given up hope
of alleviation, not to speak of restoration, and was infinitely distressed;
at the prospect of beholding another doctor who could do her no good.
Strange to say, however, before I had been half an hour with her she;

MO COKBDlJLTIOM OF NERVOUS AUD MUCOUS IlfDIOfiSTlOK.

consented to reach Malvem in some way or other — a refiblation so no^
expected hy herself, so opposed to all that she had been told to dread
from the water cure, and so unlikely at the first visit of a strange phy-
sician, that she ever since declares it, looking to the event, to be a
special interposition of Providence for her recovery.

Within a week after this interview, P. S. reached Malvem. I shall
not enter into the detail of symptoms ; she had every bad symptom
that could be drawn from either kind of dyspepsia. Two of them de-
serve mention. The tongue was enormously swollen, fiery red at the
tip and edges, and covered with a thick brown fur — signs highly indica-
tive of the complicated character of the malady. So great was the
sensibility of the pit of the stomach, and, indeed, of the whole abdomen,
that passing the hand over it at the distance of two inches, produced
convulsion of the whole surface and vomiting. This will give some
idea of the intense irritation which must have existed in the network of
ganglionic nerves within.

I began the treatment with hot fomentations on the abdomen for two
hours night and morning, a light compress over the same part being
worn in the intervals. Her food was confined to a wine-glass of barley-
water, and the same quantity of cold water at alternate two hours. The
vomiting diminished in frequency even under this partial treatment.
At the end of three or four days, I packed her in a wet sheet for half
an hour, and immediately on coming out of it, in another one for three
quarters of an hour, sponging with cold water being used after them.
The effect on the nervous system was immediate ; she declared she had
not known such calmness for thirty years. She was packed in this
double manner again in the middle of the day, and a third time in the
evening, making six wet sheets and three ablutions in the day. She
was fomented for an hour at night, and wore a compress on the stomach
day and night. The food was gradually advanced in quantity, but still
limited to barley-water, arrow-root water, and gruel. The quantity of
water was also gradually advanced, until at the end of three weeks she
was able to take four or five tumblers daily. By the end of those three
weeks, the vomiting had ceased, and has never returned for one second
of time since, tww two years and a half I must here remind the reader,
that for twenty-five yeaft this vomiting had been nearly incessant. I
must further remind him that " air and exercise," which are said by
the opponents of the water treatment to do all, and the water, in its
various apphcations, nothing, in that treatment, had no room for opera-
tion here, the patient having been in bed the whole of the three weeks,
during which the same number of wet sheets was continued, and the
whole treatment persisted in, except that the fomentations were discon-
tinued at the end of the second week. The wet sheet was the principal
agent in this wondefal change.

But broken as she was by long illness, the blood and nervous energy,.
and mnscles of the body exhausted, the restoration of the locomotive

COMBINATION OF NERVOUS jLND MUCOUS INDIOESTIOir. 101

power might be expected to be a very forlorn hope. Yet bo admirably
£d the wet sheeting and cold shallow baths (for she was soon able to
take these) act in bringing the stomach into better digestive order, and
thus in forming nutritive blood for the nerves and muscles, that at the .
end of two months she was able to walk three hundred yards, and he-
tween the third and fourth month from her commencement of the ireaimem,
she walked a few yards more than a mile cf gentle descent, rested an hour
and walked the same, ascending, back again. Here, again, let the readel
recal that this patient had, for twenty-five years, been unable to walk,
had passed the whole of that time in the bed and on the sofa. To bring
her to this power of walking, I had, of course, taken advanta^ of the
augmented power of dio^estion, and had given her gradually increased
' quantities of chicken, mutton, bread, and a small quantity of butter ;
tills was the whole of her aliment. Under its operation and that of the
active treatment, the tongue gradually threw off its brown coatmg ; this
was the first change, and it showed that the mucous irritaticHi was the
first to diminish, as it generally does ; for the diminution of the swelling
and redness of the tongue, the indications of nervous disorder, remained
long after the fur had disappeared, as did, also, the exquisite tenderness
of the pit of the stomach, another nervous symptom.

It is needless to dwell on the prolonged treatment of this case. SuflSce
it to state, that the wet sheet, the chief agent, was increased or dimin-
ished in frequency with the exasperation or lulling of the internal irrita-
tiowf tliat the cold shallow bath was in daily requisition, that the cold
sitz bath was taken as a tonic twice a day, and that she drank from
eight to ten tumblers of water daily. This continued for a year, with
various degrees of assiduity ; but long before that time had expired, P.
S. was one of the most peripatetic persons in MaJvem, walking from
three to four miles with ease. She has never " looked back," but has
gone on from good to better. Lately she has been visiting near Bir-
mingham, has gone out to dinner parties, kept the hours of the house,
and came back protesting she never was so well in all her life.

Now, had I never seen but this one case illustrative of what
the water treatment can do, I should have considered it very
good ground for reliance on that plan of treatment in diseases of
this class. A more intense degree of mucous and nervous irri-
tation of the stomach it would be diflScult to meet with, and this
was further shown by its eflfects on the tfnimal nervous system
which, for twenty-five years, had been almost entirely paralyzed
by the excessive irritation radiating from the stomach. I con.
fess that, armed only with the old mode of practice, I could have
done nothing with such a case, and no wonder, when so many
leading men, both of the metropolis and the provinces, had failed
in the attempt to do something.

lOJS RBRYOirS AND MTTCOirS DTSFSPSU.

• But this is only one of very many instances which I could give
of the extraordinary results of the water treatment in this compli-
cated form of indigestion, in which I regard it as all but infallible.
In the case just given, the effect upon the brain and spinal cord
was determined and greej; ; but this is not necessary ; the stomach
irritation may play chiefly on the nerves which are given out
from the spine to the scalp, the trunk and the limbs ; whilst the
stomach itself may be the seat of phenomena in many respects
different from, but scarcely less intense than those detailed in the
last case, although recognizing the same morbid condition of the
mucous and nervous tissues of the digestive organs. The follow-
ing case will show this, and it will also show how such frightful
amount of mischief is generated.

Case IV. — ^Nervous and Mucous Dyspepsia.

The lady whose case I now give is at present twenty-nine years of age.
Being at boarding-school in this country, in her sixteenth year, she had,
as girls during the growing age often have, a slight stomach disorder, an
ordinary passing dyspepsia. She was' inordinately dosed with medicine
for it ; upon which headache commenced, with pain in the right side.
This last was treated as liver disease, and enormous and incessant doses
of calomel were administered in combination with strong purgatives ;
blisters were applied over and over again to the right side, and kept open
with tartar emetic cerate ; and mercurial ointment was rubbed into the
side. The headaches, which were distracting, and came on after eating
meat or after being in a hot or crowded room, were treated by bleeding
from the arm, which operation was performed twice in one year, the
eighteenth of her age. Treatment on this plan was pursued during four
years that she remained at school ! long before the end of which time the
simple indigestion had been converted into an inveterate chronic one, as
may readily be conceived. Could the blindness of ignorance, could the
infatuation of drugging go beyond this ? The sequel will show that it
could.

She left the school with confirmed chronic dyspepsia, liable to blaze
into an acute form on the smallest provocative. Being a girl of great
natural spirit, her animal nervous system was not rendered incapable of
its functions, notwithstanding the irritation that had been deeply fixed in
her organic nerves. She went to Torquay, took purgatives, which had now
become necessary for her, and gentle exercise. In an evil hour, on a slight
increase of the dyspeptic symptoms, the doctor was sent for. Drugging,
more violent than ever, began : every species of medicine was tried on
her unfortunate stomach, and all in the strongest doses ; until after eight
months of this destructive process, the medical attendant declared " he
eovld do nothing more^forhe had gone through the. entire Pharmacopoeia:^

NERVOUS AND MUCOUS DYSPEPSIA. 108

Ibe ipmsima verba of this candid confession ! — a confession, too, mada
to one who came from his hands much worse than when she came into
them ! the absurd part of this treatment (a stronger epithet applies to the
treatment generally) is that, whilst this monstrous array of irritants was'
being applied to the stomach, the diet was brought to the lowest sustain-
ing point, lesi the food should irritate the stomach !

After this assurance of having swallowed the whole Pharmacopoeia,
the lady's parent had faith enough to try the circle again, and the patient
was taken to Leamington. There the diet was reversed, and was ordered
to be highly animalized and concentrated. The strongest preparations
of iron and powerful mineral acids, as well as other tonics, both mineral
and vegetable, were given, to cure a stomach in the depths of inflamma-
tory act ion ! But if the purgatives of Torquay had been strong, they
were ii .Id compared with those she now took; they kept up incessant
drastic purgation ; between which and the iron, acids, &c., her monthly
illness, which had hitherto been regular since her thirteenth year, stopped ;
whilst her dyspepsia steadily grew worse. From this unpromising prac-
tice, which she persevered in for ten months, she passed to that of ano-
ther practitioner in the same town.

Now again the diet was changed from flesh, and made to consist prin-
cipally of fish. The physic was also changed, and strong alkalies were^
substituted for strong acids. But lest they should not suffice, it was
deemed expedient, with what rational view does not appear, and it would
puzzle the profoundest pathologist to discover, to maintain a state of con-
stant nausea with a variety of emetic medicines. Yet whilst it is univer-
sally acknowledged that nausea is a state of excessive stomach irritation,
and whilst it was maintained by the emetics alluded to,— at the very time
it was deemed necessary thus to keep up excessive irritation of the
stomach, it was also deemed essential to apply burning moxas over the
region of the stomach to ceunteraci irritation within ! Moxas externally,
and emetics, purgatives, and fish internally, were persevered in for one
year : for one whole year the patient was kept in a state of incessant
nausea I Further, as by the former treatment, the monthly illness had
been stopped, and the present one did not restore it, artificial reHef waa
attempted by opening a vein in the foot, and allowing a free bleeding
once a month. The result of all which was a reduction of strength, both
organic and animal, which was alarming. It should be noted, that on
one occasion both practitioner and patient were frightened at the symp-
toms of prostration caused by the nausea and purgation, and agreed to
eight days' respite from all treatment; to this hour she speaks with
energy of the immense relief she experienced during those days ; they
formed an oasis in her year of misery.

One year and ten months of Leamington treatment was deemed a rear
sonable trial. She was now taken to her native place, Dumfries. Her
attendant there, addressing his skill to the restoration of the monthly ill-
ness, was so successful in that particular as to bring on the opposite

104 NBBTOUS AND UVCOUS DYSPEPSIA.

extreme, and she was drained of blood. The medicines by which tbig
was effected caused her exquisite internal pain, which was not improved
by the violent purgatives that were liberally given. However, the illness
restored, no opportunity was given for prolonged medication. She was
taken to the Isle of Man for change of air. There she remained between
eight and nine months ; but her dyspeptic sufferings led her, — for when
does hope of relief cease ? — to seek medical advice again, notwithstand-
ing the sad experience of the last six years and a half, and for months
she took blue pills daily ; for by this time so exhausted was the power
of all the digestive organs, that some such stimulant to secretion was
actually necessary, and the medical men who prescribed it had no other
alternative in the list of the usual remedies. It is necessary to add, that
purgatives always were in requisition. At the end Of nine months she
married — ^being in her twenty-third year — and went to Grermany, where
she travelled about for several months, staving off" her most distressing
symptoms with soda, sal-volatile, opiates, &c. She returned to Dum-
fries, and was confined with a female child. During her pregnancy her
dyspeptic signs were much relieved, the organic irritation being trans-
ferred, for the time, from the stomach to the womb. After confinement,
they returned with renewed intensity, and now showed signs of extension
to tho air tubes of the lungs. The inflammation of tlie ganglionic nerves
of the stomach also now caused great and constant pain between the
shoulder blades. The attendant (who I hope and presume was " inno-
cent of the knowledge" of the stethoscope) made up his mind, from the
cough, expectoration, and pain in the back, that she was far gone in pul-
monary consumption, and announced it so. How did he treat (hat 1 She
was confined to a heated room, wore a respirator, had leeches and cup-
pings between the shoulder blades, and constant blisterings ! Strange
enough treatment for consumption ! but how much stranger for indiges-
tion ! which it was ; for on taking courage and getting away to tlie Isle
of Man once more, all the chest symptoms disappeared, but the dyspeptic
were there as before.

From this period she travelled about and stayed at home alternately,
always suffering from intense dyspepsia, always taking purgatives, soda,
tonics, &c., but never one bit better. At one date she was induced to try
what homoeopathy could do for her, and the result, as far as the headache
and some other nervous symptoms went, was very satisfactory. It does not
appear, however, that circumstances allowed of her giving it a long trial,
nor of her being near the medical prescriber. Still homoeopathy was tlic
first treatment that had done her any good ; that had not, indeed, done her
positive harm. But to crown the history of this most unfortunate case,
a series of feverish sjrmptoms broke out, a short time before she came to
Malvern, which were mistaken for rheumatic fever, for which she was
bled in the arm, frightfully dosed with calomel and opium, &c. After six
days of tliis mistake, an eruption of measles took place, of which all these
feverish signs had been the forerunner ; and there is little doubt that had

NERYOtrS AND SUTCOUS DYSPEPSIA. IW

tlie body not been interfered with, and its powers depressed and mis-
directed by the treatment just mentioned, the eruption would have taken
place much earlier, and the constitution have been spared the prolonged
struggle to throw out the measles, the debilitating efiects of the bleeding,
and the irritating effects of the calomel. However, her elastic nature got
her round, and it was on her recovery that she came to Malvern ; not
with a view of remedying her now complicated ailments — ^for she had
given up all hope of that, — but with the desire that her husband should
try the water treatment against a formidable amount of nervousness with
which he was troubled.

Here, then, is the instructive history of a disease which commenced in
a simple attack of indigestion in a growing girl of excellent constitution-
Had comparative, or, if necessary, total abstinence from food been practised
for twenty-four hours, and only dilution with thin gruel and toast-water
allowed, there can be no reason to doubt that, in such a constitution, the
digestive organs would have recovered themselves, and all would have
been well ; but the first unnecessary does of calomel led to all the subse-
quent mischief; it set up the irritation upon which all the subsequent
practitioners played, each one having his own tune, the discord and con-
tradictions of some of which I have briefly exposed en passoTit. No
apology is necessary for the length of this account ; it is not often one
gets so complete a narrative of the growth of a long illness ; and a great
deal may be learned from it. I may state, that it is from the lips of the
patient herself, who, summoning up the treatment she had undergone,
exclusive of medicines, tells of nine bleedings from the arm, bleedings
from the foot every month for a year, leeches without number, and to all
parts of the abdomen and chest, cupping frequently, blisters innumerable ;
and, adding up the medical men she consulted during those years of
suffering, she finds tliem reach tlie dreadful number of twenty-two ! In
the above account, only those are mentioned under whose care she re-
mained for a prolonged period.

To return. This lady reached Malvern in the month of March, 1844.
The account of her at that time is as follows. Incessant and frequently
very violent headache, at the back or the top of tlie head, or over each
eye. Sleep most uncertain, always broken and busy. Vision constantly
annoyed with black spots. Pulse small, hard, rapid, having all the signs
of intense irritation. Tongue fiery red, split in all directions, and swol-
len ; not oflen dry and not much furred ; gums very red and spongy ;
throat always more or less sore, and exhibiting small blisters or pustules,
which, after causing immense irritation, came off; constant and intense
burning in the stomach ; extreme tenderness on pressure over the pit of
the stomach ; acute and constant pain in the back between the shoulder
blades ; appetite very capricious, but, when present, always small and
requiring tempting cookery. Pain after eating everything, with fluid
risings of extreme acidity, which obliged her to take soda after every
meal ; even a wine-glass of spring water rose acid in the mouth soos
6*

100 NEHVOUS AND MUCOUS DV8FBPS1A.

ftfter being swallowed. Indeed, this had been the case for twelve yean^
during all which time also she had been altogether unable to take cer«
tain articles of diet, so great was the pain they caused, among which
were especially bread and tea. The whole abdomen was enlarged by
flatus at all times, but especially after eating the smallest morsel. There
was no action of the bowels whatever, without the assistance of medicine.
The kidneys showed morbid action in the character of their secretion, which
was charged with pink sediment and gravel. The monthly discharge
was effected with extreme pain, was scanty and pale, and never continued
longer than two days, very often not more than one. There was great
sense of bearing down of the womb, which, in fieict, was considerably
fallen down, swollen, and heavy. Thus there was not any part of the
abdominal viscera which the digestive irritation had not reached and
involved. Its extension to the brain was shown by the extreme nervous-
ness under which the patient constantly labored, as well as by the want
of sleep, &c., already recounted. The chest had escaped the mischief:
nor, although she had been treated as one far gone in pulmonary con-
sumption, could any the least disease of the lungs be detected.

Externally, the frame gave everywhere signs of bad nutrition. The
skin was palo, and the flesh soft and inelastic. The walking power was
in keeping with the innate and the morbid nervous character of the
patient ; she could walk strongly and quickly for a short time — ^this her
impulsive nature permitted ; but exhaustion soon followed ; there was nc
sustainment of the power — ^this her morbid nervous system did not permit.
Indeed, throughout her long illness, the elastic nature of this patient had
been exhibited ; and without it, without the spirit it imparted, she must
have sunk under the multiplied aihnents, or been the victim of some in-
ternal organic disease.

The treatment of this complicated case by water was spread over many
months ; and I shall, therefore, not attempt any detailed account of it, but
recite the chief stages of its progress. It commenced with only the rub-
bing sheet every morning : the compress on the abdomen day and night :
the restriction of diet to cold liquids, and the simplest solids : and the
taking of two or three tumblers of water in the day. Fomentations for
an hour at night were added to these ; and, soon after, packing in the
wet sheet, which at first was practised once and afterwards twice a day ;
the cold shallow bath being used after each of them. The sitz bath was
prescribed once and then twice daily, so soon as the walking power
showed signs of more continuous energy ; and this it did, by the fact of
her being able to take exercise before breakfast for a half and then for a
whole hour — a feat she had never been able to compass : for although
much urged to do so when at Leamington, tlie attempt even for a few
minutes always ended in faintness and total loss of appetite. During
the period when these processes were being gradually increased, the
quantity of water was also increased, until she took from twelve to fifteen
tumblen daily; and for several days ahe took, withoat my direction

NERVOUS AND MUCOUS DSTSPEPSIA. 107

flowever, as many as twenty. It should be stated, however, that some
of the water she drank was always rejected from the stomach in a per-
fectly acid state : this continued for many weeks. It was also during
the process of wet-sheet packing, that the appetite underwent a marked
improvement, it became more decided and more steady. The bowels re*
mained exceedingly torpid now that they were deprived of their usual
purgative stimulant : still they acted to a small extent, and I was con-
tented with that, as the general treatment obviated feverishness, and it
was essential, at all o'her risks, to withdraw utterly from the digestive
canal the drugs which had so grievously damaged it.

When it appeared to me that the active irritation bad been subdued to
a certain extent, I hoped, by the sweating process, to rouse the secreto-
rial activity of the liver, and general mucous membrane of the digestive
canal. That process was therefore tried with the efiect of bringing
about a somewhat better action of the bowels. It was alternated with
the wet-sheet packing, and at the same time the sitz baths were con-
tinued, as also the compress, and the copious water drinking.

{Such is an outline of the treatment which was persisted in for nearly
six months, with the striking results of rendering the stomach far more
tolerant of food, reducing the acidity, gnawing, and burning of the sto-
mach, inducing a state of bowels, not quite satisfactory, it is true, but
which allowed of their occasional action always without medicine, procur-
ing more sleep, and generating an amount of walking power to which she
had long been a stranger. Her dyspepsia — the accumulated dyspepsia
of so many years of bad treatment — was indeed far from being cured ;
but it had gone infinitely further in that direction than hitherto, and all
the patient's sensations announced it. In the midst of the general
organic excitement which the treatment had aroused, whilst all the
organs were laboring to relieve themselves, a strong mental agitation
occurred to her, and nervous f ever. aimounced itself in her unlucky frame.
Whether a fever would have been the crisis of her complicated and pro-
longed complaints, as I often anticipated, or whether this particular one
stood in that character, it is impossible to say, inasmuch as the coinci-
dence of a mental agitation leaves the possibility of its originating from
that cause alone. It was, however, the most violent and perilous I ever
beheld. How it was treated is not germane to the history of the dys-
pepsia ; but some idea of the activity of tlie treatment may be gathered
from the fact, that on one day she was folded in twenty-one successive
wet sheets between 6 A. M. and 11 P. M. At the end of six weeks she
was tolerably well recovered, and I recommenced the treatment of the
dyspepsia. As excessive irritation no longer existed, I did not urge any
great amount of treatment. She was only packed once a day with a
towel in the front of the body, the cold shallow bath after it, and sitx
baths of twenty minutes each twice a day : tlie quantity of water was
moderated to five or six tumblers in the day. In this manner, with the
•dditioo of occasional fomentations, she went on gaining in her gastrio

108 IfSEVOim AMD MtrcOUS DYSFXP8IA.

sensations antil the month of March, 1845, just one year afier hm
arrival at Malvern, when she became enceinte. As no reliance could
be placed on the strength of the uterine organs, it was deemed best
to suspend all treatment, except the morning ablution with cold water.
The period of pregnancy was entirely free from suffering, save from
occasional bad headache, and pains down the legs. But she ate and
drank of anything with impunity, and she gained flesh. This, no
doubt, was due to the transfer of all visceral irritation to the womb,
and I did not expect this perfect state of digestion to continue after
delivery. That event happened in December, 1846, and the child was
a superb one, weighing twelve pounds at the birth. Now that she has
recovered, she sums up her gains to this date, in the abolition of all
painful and distressing sensations after eating, in a better appetite. In
the total removal of acidity of. stomach, in the capability of taking a
number of articles of diet which her stomach has not been able to
tolerate for many years, in the improved state of the bowels and eman-
cipation from drugs, in a much healthier state of the monthly discharge,
and absence of all morbid sensations about the womb, in better sleep,
and in firmer flesh. Against these are to be placed the occurrence,
from time to time, of severe nervous headaches, such as she used to
have almost continuously, frequent tic pains about the hips and legs,
and rare paroxysms of nervousness. Still her viscera, her vital parts f
have been saved from organic disease, to which they were hurrying ;
the substantial malady, the diseased circulation of the internal parts,
, has been subdued. The sensations, the nerves, are always the last to
yield in all maladies, and I fully expect they will do so in this trying case.
Be it remembered, meanwhile, that the whole time occupied by the
patient in the active and steady pursuit of the water plan does not ex-
ceed ten months. She is now recommencing its active employment,
with the aim of ridding herself of the morbid nervous phenomena which
still remain out of the long list of dangerous symptoms which she had on
coming to me, and which she very reasonably attributes to the atrocious
drugging to which she had been subjected.

If the reader would hear all the " previous histories" of cases
that are detailed to me, and which all resemble more or less that
just given, — histories of violent and irrational experiment, not to
call it treatment — and then could see the appliances of the water-
cure calming down morbid sensations, and abolishing morbid
actions that had existed for years, and had been intensified by the
rude attempts of aimless medication, he wcnld wonder how thia
last continues to flourish, whilst the simple, yet potent hygienic
plan of the former is pointed at as certainly destructive of health,
if not of life. Here is another case in which all treatment,— at
least, all the treatment which two and twenty medical men could

nXEVOUS AND MVCOim DrSPBPSU. 109

propose, — ^was essayed, and from edch one the patient came out
Vforse. NoW) had she only not become worse by the water treat,
ment, the superiority of the latter would have been demonstrated :
it would have been autant de gagne instead of so much loss.
But with such a result as this patient can vouch for, it would be
preposterous to deny the immense power of the water plan, and
its far greater certainty of action in dyspeptic cases, over that in
ordinary usage. In short, in the three kinds of dyspepsia which
have been treated of, this hygienic treatment is the only one that
offers any prohabiUty of cure. Relieve, palliate, wind up the
stomach to the digestion point as you will by medicines, it falls
back to its old point of irritation and its former bad habits the
moment your remedy is suspended, atid, after a time, in spite of
your remedy being continued. The stomach is not allowed the
opportunity of recovering itself, the only recovery that is worth
anything : it will not, it cannot be forced into recovery. Even
when that most rational part of the ordinary treatment of dyspepsia,
rest of the stomach, country air, and regulated exercise, is had
recourse to, — and it is seldom advise d until medicinal remedies
are exhausted, although it ought to be the Jirst to be tried, — ^the
beneficial consequences which might flow from it are constantly
obviated by the mischievous superfluity of some medicated water
or some cordial bitter, in deference, very frequently, to the strong
prejudice and feeble understanding of the patient. But however
strong, however general, the prejudice, and however true it may
be that, in diseases of organs distant from the stomach, medication
may be curative : I cannot but repeat the strong conviction I have
that medication never did, never will, never can, cure a case of
chronic dyspepsia : and that, short of organic change, the hygienic
wafer treaimenl seldom if ever fails to cure it.

§ 4. Gastko-knteritis. — Chronic Inflammation of the
Stomach and Small Bowel. — Atrophy. The two former of
these terms signify the same thing, the first being the technical,
the second the vernacular expression. The third, atrophy, or
wasting, is the consequence of the double iDflammation of the
stomach and small guts. I will endeavor to render the connection
between them clear.

The mucous membrane which lines the stomach continues its
course downwards to the bowels, lining them also. Arrived at
fhe first, it is pierced in innumerable points with small orifioes.

110 CHBONIG INFLAMMATION OF TBS

which are the mouths of most minute tubes, the insides of which
are also lined with prolongations of the common mucous mem-
brane of the bowel. Now the office of these mouths, of these
tubes, is to select and absorb the chyle or white blood as it
descends from the stomach after digestion, and after the addition
of the bile en route ; and the office of the tubes themselves is ta
convey this white blood into the great vein which finally pours its
contents, as yet unfit to nourish the body, into the heart, which
propels it into the lungs, there to be exposed to the atmosphere,
to become red blood, and to be rendered fit for the purposes of
nutrition. It will be plain, from this sketch, that whatever
prevents the free absorption of the chyle in the small bowels,
prevents the nutrition of the whole body : and as the waste of the
body of necessity goes on, the want of a recruiting supply from
the organs of digestion is the exciting cause of its atrophy.

More or less atrophy always attends the chronic inflammation
of the small bowels, because the mouths of the absorbent tubes
alluded to, are more or less inflamed and swelled in common with
the lining membrane of the bowels on which they debouch, and
the passage of the chyle through them is more or less prevented.
This isolated disease of the small bowels is more commonly seen
in growing children, probably in consequence of the excessive
labor of those parts necessitated by the process of growth. But
in adults it is more frequently accompanied by a similar inflam-
mation of the stomach : hence the compound technical name it
bears. This of course complicates the malady : for in such ciase
there is not only obstructed absorption of chyle, but chyle of a
badly elaborated kind, unfit for the healthy nutrition of the frame,
which thus suffers both in deficient quantity and quality of
nourishing liquid.

The symptoms, as far as the stomach is concerned, are those of
nervous and mucous dyspepsia, the appetite being capricious,
ofttimes voracious, with sometimes suflfering, at other times none,
after eating. But, in so far as the small bowels are implicated,
the symptoms vary considerably, except in the emaciation, which
is always in greater or smaller degree. When the inflammation
is less diff'used over the lining of the bowels, more concentrated
in one spot, and more intense, as evidenced by feverishness, the
wasting is not so great (the reason for which will be clear from
what has preceded), but the brain phenomena of irritability,
lestlessness, sleeplessness, and headache are more deoidisd ; fox in

fiTOMACH AND SMALL BOWSL. Ill

diat case the brain is tolerably well nourished, and is therefore in
better state to recognize and react upon the irritations proceeding
from the disordered viscera. The circulation of blood also is
more vehement, the pulse is more excitable, and fever is thus
more readily induced. Hence the sleepless feverish nights of
patients suffering under gastro-enteric disorder of this kind.
The skin is dry and hot, especially of the palm of the hand.
The tongue is of the kind called " strawberry," that is to say, its
papillfiB are very red and elevated, and between them there is a
whitish mucus, the two giving the appearance of a ripe straw-
berry ; it is also inclined to dryness. There is sometimes, but
by no means invariably, a degree of tenderness on pressing the
bowels, which are shrunk, giving the abdomen a constricted, hard
feel. Constipation is usual. This kind of gastro-enteric inflam-
mation may end by wasting from continued, smouldering fever,
or the sympathy with the brain may render that organ too full ot
blood, and apoplectic or paralytic seizure may take place.

When, on the other hand, the inflammation is general over the
surface of the small bowels and of a very chronic character, the
atrophy is decided and great, and the brain phenomena less
urgent; on the contrary there is generally a tendency to
somnolence and inactivity and depression of mind. Neither is
there much fever, and what there is of it is of a fitful, hectic
character. The skin is devoid of moisture, but not without soft-
ness. The bowels are irregular ; being sometimes in a relaxed
state, which is due to the fact of chyle, and other matters, reaching
the lower bowel, in which, as it was never intended to receive
them, they act as unnatural stimulants, and provoke it to
excessive action. At other times they are veiy torpid. The
abdomen partakes of the general emaciation, and feels like a
board lying close upon the spine, so contracted is the calibre and
substance of the bowels. The evil termination of this state is by
fainting, the brain ceasing to receive sufficient blood to perform
its functions, and the heart, deficient in energy from the same
cause, failing to send blood towards the brain.

In deciding on the treatment of this chronic inflammation of the
stomach and small bowels, we must ascertain which of these
phases of it exists, and I have given the chief differences by
which each may be known. The gastro-enteritis without much
emaciation and with fever, admits of more decided treatment than
the atrophic kind. Besides fomentations, the wet sheet is appli.

1^ CHROMIC IMFLAVBIATIOR OP TUB

cable : the water drank may be more copious : and exercise mom

extended, though never long continued. In atrophy the wet sheet
is scarcely admissible, the vis vita being insufficient, in the first
instance, at least, to react upon it ; and for some time all that
can be done is to foment, compress, and use friction over the bowels;
to apply friction over the whole body, with cloths wrung at first
out of water at 90°, and gradually diminish the temperature :
to give water to drink sparingly, and not under 50° : and to
observe the most perfect rest from exertion, the frictions being
a substitute for exercise. It is a condition requiring the utmost
nicety of treatment, so small and easily overwhelmed are the
organic powers on which we have to depend for self-restora-
tion. T hesitate not to say, were the water treatment applied
in this malady, as it was recommended when first introduced into
this country, that is to say, with mccssant wet sheets, cold baths,
and numberless tumblers of cold water to drink, every case of
this malady would end fatally.

On one point in the treatment of this disease, it is very neces-
sary to dwell, — the diet. It might be supposed that as much food
as possible should be prescribed in wasting, especially as there
is, very commonly, appetite for it. Yet it is very imprudent to
permit any but mild articles of diet, and those in small quantities
only, for a time. It should be remembered that we have to deal
with the caiise of the wasting, and that cause is inflammation of a
membrane to which the food, both before and after conversion
into chyle, is a stimulus : on this score, then, it is desirable to
limit the quantity and quality of food. But, moreover, it may be
asked, of what avail is it to give the stomach large quantities of
strong food to convert into chyle, when that chyle cannot only
not be absorbed, but will pass down to the lower bowels, produce
irritative diarrhcBa there, and in this manner actually hasten the
dilapidation of the body it was intended to maintain ? Plainly
enough this ought not to be done. The patient should take the
mildest farinaceous diet in small and oft repeated quantities : but
whilst thus reduced in diet, he should also be reduced in the wast-
ing act of physical exertion : his exercise should be quite passive,
and the repose of the body complete. By this means, whilst the
active treatment is gradually withdrawing irritation from within to
the exterior, the negative treatment of diet is withholding irritations
which would be applied to the internal morbid part itself: the
cessation from exercise rendering the restricted food suffident fair

•TOMACH A»1> SMAIX BOWSU lit

mgiome support though not for animal exertion. By oommenciog
the treatment thus we are enabled piadually to steal a march on
the inflammation, which produces all the wasting, and, though a
long and tedious operation, to get rid of it. In the form of the
disease where the emaciation is not so great, and the feverish-
ness greater, both these precepts of negative treatment require to
be modified in favor of better diet and some exercise. In fact,
this latter malady demands, with very few and trifling variations,
the same treatment as the nervous and mucous dyspepsia : and,
though many cases have come before me, I need not illustrate it
by one of them, involving, as it would, some tedious repetitions.
I shall, however, offer a brief account of a case of atrophy, or
wasting, which terminated well under my care.

Case V.-t-Atropht or Wasting.

Great mental distress was the exciting cause of the gastro-enteric in-
flammation which led to the atrophic wasting of the patient in this case,
who was a man of twenty-six years of age. (I would here remark how
often mental causes induce inflammation of the bowels as well as of the
stomach.) Commencing as simple dyspepsia, the disease soon gave the
signs of the extension of the mischief to the small bowels. Headache,
irritability in place of depression of mind, restlessness, unquiet and short
sleep, feverish -skin increased by food, obstinate bowels, &c., all indicated
the more circumscribed irritation. All this was going on some time be-
fore he saw me : and against it opiates for tlie sleeplessness, purgatives
for the bowels, a course of mercury to do something (it was not clear what),
and a course of iodine in the shape of hydriodate of potassa, to do some-
thing still more obscure, were tried in succession, and each found wanting.
Strong aliment too, and strong tonics, were given to prop the failing flesh
and strength, and change of air to change the stimulus . all to no pur-
pose. The youth went from bad to worse, and at length came to me in
a state of half stupor, volition almost gone, and the limbs over which it
was to be exercised reduced to skin and bone, the skin bloodless, the
tongue, gums, and roof of the mouth whity-brown, and having a lifeless
appearance, the abdomen shrunk to the smallest dimensions, cold flabby
hands, dull eye, weak voice, short breathing, small slow pulse. He had
frequently purging of the bowels for a day, accompanied by swimming
and faintness of the head. Appetite of the same irregular kind, though
more usually great than otherwise. Altogether he had been ill for up*
wards of four years.

His horror of cold was so great, and his reactive power so small, that
I could not for nearly a month do more than foment the abdomen at night
fisr half an hour, keep the compress wrung oat of tepid water on It, have
mm limbs and trunk well tMjed night and morning, with towels wet

414 DSOftDEKS OF THE LtVBtt AND mrODENUM.

4vith warm water, and keep him on the sofa; the only exercise he tool
was an airing in a Bath chair for an hour dally, and luckily the fine
weather rendered this pleasant. The only food he had was cream widi
tepid water and sugar, biscuit, rusk toast, the various farinacea and
rice, flower of cauliflower, and occasionally grapes : all taken in email
quantities at a time. Before the month was out, and by a graduated
process, I had got him to bear friction with a cold wet towel, and to feel
60 much better for it as to desire it. He drank a wine-glass of water
frequently, but altogether not more than two tumblers in the day. I now
discontinued the fomentations, and used the frictions three times a day ;
giving him more time for passive exercise in the air : the compress was
worn night and day : the food the same. After a fortnight of this, I
ventured on the towel packing in front of the body : he was obliged at
first to lie as long as two hours in it, without thoroughly warming it :
but by degrees this was shortened, and by the end of the second month
he warmed a towel placed behind as well as in front. Another month
brought him to the envelopment in the entire wet sheet, once at first,
and then twice a day. At this point he began to use the shallow bath
instead of the rubbing sheet. Previous to this time I had allowed him
to take some mutton, chicken and veal broth, thickened with rice or
barley, once a day : but still forbade walking exercise. Neither this,
nor a small quantity of boiled mutton, was permitted until towards the
end of the third month : neither agreed with him, and they were discon-
tinued for nearly three weeks longer, when he was enabled to take the
equivalent of a mutton chop, and twenty minutes' walk with impunity.

After this point it is needless to give details The above will afford
an idea of the gradual and cautious manner in which the treatment of
such cases requires to be entered upon, and to throw considerable doubt
on the statements imported from Germany, of persons with very little blood
in them, and less flesh on them, being plunged into cold baths of all
kinds at the very outset, and picking up flesh a vue d^oRil ; all which is
exaggerated rubbish. Of this I am certain, that had I done so with this
and two or three other patients in nearly the same plight, I should have
extinguished them, and the little flesh they had would have gone iis
usual way. As it was, it required full seven months of the water treat-
ment to place this patient in anything like condition : he had regained
the nutritive power, but even then he had a great deal to regain to reach
his former status. This patient had no critical action : from which I
conjecture that a naturally vivid constitution had enabled him to throw
off the mercury and iodine as he took them, they not remaining ii^ the
circulating blood, but helping to establish the visceral irritation which
had interrupted the nutrition of the body in the manner I have explained.

^ 5. Disorders of the Liver and Duodenum. I have been
desirous to exhibit in an isolated form the phenomena which art

mSOKDEES Oi THE LIVER AND DXTODBNTrM* 118

attached to the pure irritation of the immediate primary organs of
nutrition, the stomach and small bowels. It must be remarked,
however, that cases wherein those organs exclusively exhibit a
morbid condition are rare. By far the greater number of in-
stances of dyspepsia involve the great accessory organ of diges-
tion — the liver, in degrees that vary from simple irregularity of
function to enlargement and hardening. Irritation of the duode*
num (the short bowel which is between the stomach and small
guts), where the gall ducts empty the bile to join the chyme as
it flows from the stomach, is also a not unfrequent element in
dyspepsia, and is always more or less connected with chronic
diseased action in the liver. Still, nervous or mucous disorder of
the stomach itself always precedes the malady of either and both
of these organs, and the consideration of it, therefore, naturally
antecedes that of the duodenum and liver. These last, moreover,
exhibit symptoms that are independent of the general symptoms
of dyspepsia — symptoms which, added to those of stomach irrita-
tion, give origin to the state called biliousness : a term, be it said
in passing, used alike when there is too little and when there is
too much bile flowing : of which more anon.

The same nerves of the great ganglionic net-work situated at
the pit of the stomach which supply the latter, also by branches
supply the liver ; and the same mucous membrane which lines
the stomach extends to line the duodenum, and thence, through
the common gall duct, to line every one of the numberless rami-
fications of it in the liver, terminating, after infinite subdivisions,
in the jminutest points, where the great work of biliary secretion
goes on. In the liver, therefore, as in the stomach, we have to
view two kinds of derangement : one dependent on disordered ner-
vous supply, the other on fixed mucous irritation. As regards the
duodenum^ we have no means of ascertaining its nervous disorder
as distinguished from its mucous inflammation, which is one of the
most formidable and intractable of digestive diseases. Still, as
duodenitis — as chronic inflammation of the duodenum is called —
never exists apart from disorder of the liver, I shall speak of
both at once, only stating, as I proceed, what additional signs
* mark its co-existence with diseased liver ; which may exist with-
out duodenitis

Disordered supply gf ganglionic nervous energy to the secret-
ing capillaries of the liver is caused by sympathy with some
Other organ, and almost entirely by the brain and stomach. Any

116 DISORDERS OF THE LIVER AND DUODSinnt.

mental shock on the brain is reverberated on the great digestive
centre of nerves, and tells immediately on the stomach, and very
frequently on the liver also. In fact, some passions are said to
act more exclusively on the latter organ, such as vexed amour^
frapre and jealousy.- The nervous shock thus propagated de-
ranges the secretory action of the blood-vessels of the liver either
to diminish, to increase, or to vitiate the bile. Thus we see pow-
erful mental emotions sometimes arresting the flow of bile into
the intestines, and causing its retention and appearance in the
skin in the shape of jaundice : or in other cases the shock causes
augmented action, as evidenced by bilious vomiting or diarrhoea,
generally of a diseased character. These are severe cases : but
that shocks of a minor degree produce biliary disorder of a minor
degree is certain. That disorder claims the epithet bilious, and
it behoves the physician to ascertain whether the fact of suspended
or augmented flow of bile is attachable to the term.

Sympathy with a dyspeptic stomach is another originator of
nervous derangement of the liver. It may be presumed, and facts
show it, that, at all times during dyspeptic irritation, there is a
stream of morbid sympathy flowing thence towards the liver, and
maintaining there more or less morbid action. But it is equally
demonstrable that when temporary exasperation of the dyspepsia
takes place, an acute attack of nervous biliousness also supervenes:
and this more especially in nervous dyspepsia. The process
consists generally in first diminishing and subsequently augment-
ing the secretion of bile : the reason for which is plain from what
was said in the first part of this work on the subject of extension
of disease.

A similar, though a more permanent irritation is established
when the mucous disorder of the stomach produces mucous dis-
order of the liver. This occurs more especially when the right
or lower end of the stomach is the seat of disease : and as, in
extending to the membrane which lines the gall ducts, it has to
pass by that which lines the duodenum, the mucous dyspepsia is
'that which usually originates inflammation of the duodenum.

Whether, therefore, there be nervous or mucous biliary dis-
order, the nerves or lining membrane of ihe stomach are first of
all affected. This involves the question of the modus operandi
of medicines called antibUious. As I have said before (page 11),
no internal remedies can reach the liver save through the Stomach :
to rouse the former to' action you must rouse the latter: yon

l>ISOftI>fiE8 OF THE LIVER AND DlTODBNUK. 117

atrike at the liver through the stomach. So that whilst you think
how cleverly you are urging the liver with calomel, you should
also remember that the spear is being driven into the stomach,
which may, nay certainly is, irritated before the organ you desire
to act upon. AtUiMlious is thus synonymous with irritating the
fUmiach : and those vulgar dietetic remedies against " bile " (a
wild sort of term, used to express all and everything concerning
the liver), viz. bacon and brandy-and-water, are the best remedies
ioT perpetuating dyspepsia, at the same time that, by causing a
temporary stimulation of the stomach, they are esteemed and^
taken by the populace, not only as antibilious, but anti-dyspeptic !
At least, it would be well to ascertain first of all in what the
UUottsness consists : is there too much or too little bile ? for the
term is applied to both facts, and although bacon, dec, may rouse
a torpid liver, is it pretended that it will calm an over-active one ?
The folly of all this lies in the treatment of a word, biliousness,
instead of looking into the state of the biliary organ. One man
with a yellow skin, and another man with a florid clear skin, com-
plain of bitter mouth and biliousness, and would treat themselves
or be treated in like manner ;* the fact being, meanwhile, that
their livers are in diametrically opposite conditions, the former
being too torpid, the latter too active. There is a great deal of
pig-headedness abroad on the score of this " breakfast bacon," and
if the reader beheld the tenacity with which patients cling to their
bacon, he would acknowledge the necessity for these animadvert-
ing remarks.

Biliousness, then, signifies disordered action of the liver of a
nervous or mucous character : and that action may cause deficient,
excessive, or vitiated bile. The signs of dejkient bile are, yellow-
aess of the white of the eye, and of the skin generally, if the stop-
page be great; yellow, bitter tongue, thick saliva, acid breath,
and sour risings, deficient and highly colored urine, deficient and
pale evacuations from the bowels, dry, obstinate, itchy skin, inap-
petence, dull headache, somnolence, slow, laboring pulse. The
signs oi excessive activity of the Uver are, flushing of the face, espe-
cially of the nose and chin, some bitterness of mouth, clean red
tongue, with red pimples along the sides, sore or relaxed throat,
hot breath, bitter risings, copious urine, especially at night, bright-
yellow evacuations, of a very small taper-like calibre, piles, dry
skin exceedingly sensitive to changes of weather, great appetite,
but with occasional fits of nausea ; acute nervous headache, irri-

418 DISOEDSBS OF THE LIYSB AND J>VOJ>ES(UU,

tability, restlessness, rapid pulse. The signs of vitiaied hUe being
secreted are those of the last-named condition, except that the
appetite is indifferent, the urine rather high colored, the intestinal
evacuations dark or greenish, and burning as they pass ; there is
more or less spasm in the region of the stomach, and sometimes
piles, at others only itching of the anus. It is in this state that
the bile sometimes is so thick or so acrid as to produce vehement
spasm of the gall dqcts in its passage ; and that the concretions of
l)ile called gall stones are formedj and cause the same spasmodic
state in their passage into the duodenum.

Irritative action is the basis of the two latter of these states, and
congestion of the former. When the liver cannot secrete bile, it
is because it is oppressed by a load of blood throughout its whole
substance ; it is a state of feebleness from oppression, and requires
a diversion to be made in its favor. The diversion which nature
makes is most commonly by sweat, rarely by the bowels. When
the liver acts too vehemently, or secretes bad matter, it is because
the minute extremities of the gall tubes, and, in the case of exces-
sive action, the larger tubes also, are in a state of inflammatory
irritation, the rest of the liver being in its usual state. Here the
aim is to lower, to reduce redundant action, to calm the functions
of the liver. From all which it will be perceived, that it is of
importance to determine what is meant by hiUotisness, and that
one remedy will not do for all kinds of it,

A disordered liver generally begins with excessive and ends in
deficient action. The repeated attractions of blood towards its
secretory tubes, caused by stimulating food, the passions, &c.,
each time more and more enfeeble the self- restorative power of
the organ, whilst as, each time, more and more blood accumu-
lates in it, in consequence of th's waning power, the whole mass
becomes at length congested, and the passing attacks of bilious-
ness become a permanent state of jaundice. I need not remark
how much the usual treatment of those attacks by mercury must
tend to hasten the feebleness alluded to, by tlje over-stimulation
and the exhaustion of the capillaries of the part ; until at last,
when they most need to be stimulated, the medicine to which
they have been so long accustomed fails to excite, and leaves
them helpless. In this helpless state it is that so many livers
come to the water treatment.

Congestion once established, it goes on to swollen Uver, a con
dition which I would compare with that of a sponge expanded

i>isobd£k:5 of the liver and duodenum. Ili9

with water : there is no actual addition of substance, but only ao
expansion of the natural cellular substance of the organs. This
state is curab^e. But if it persist for a long time, and be still
irritated by attempts to forct it to secrete bile, the accumulated
blood in it begins to deposit additional substance ; sometimes like
that of the liver, at others of a yellow, tallow-like appearance,
and hard, or a mixture of both. This is enlarged liver : it is not
curable, and can only be prevented from extending further.
Many of the symptoms it gives rise to may be palliated, and the
portion of it which is only swollen may be reduced, by the water
treatment ; but the changed structure can in no way be removed.
This applies still more to the last stage of liver disease, hard-
ened liver, which is a wasting of the cellular tissue of the organ,
and an encroachment of the morbid structure already mentioned;
so that all its secretory parts are annihilated, and it remains a
hard inactive mass, dangling under the right ribs, and acting only
the part of a foreign body, irritating the rest of the body directly
by its presence, and indirectly by the non-fulfilment of its import-
ant function. The signs of each of these conditions are suffi-
ciently decided ; but the enunciation of them here would be too
long for the aims of this work. But such as I have described if
is the progress of disease of the liver. At first an attack of
biliousness, connected, probably, with nervous dyspepsia ; thei>
the mucous membrane becomes involved by repeated attacks of
that kind, and by repeated treatments ; next, the mucous attacks
at length involve the cellular tissue, and congestion is established,
which, in process of lime and of further irritation, passes into
swollen, thence into enlarged, and finally into hardened liver.

Let the reader, meantime, picture dyspepsia in its various de-
grees of intensity accompanying tliese phases of biliary disorder,
and aggravated, pari passu, by the irrational plan of stimulation
generally pursued, and he will find abundant cause for the haggard
looks, the failing strength, the irritable temper, or indifferent stupor,
and the annihilation of all enjoyment, which mark the biliary dys-
peptic. And the end of all this ? In some, the stoppage of the bilia-
ry secretion causes the elements of the bile to be retained in the
circulating blood, and to be presented to tissues to which it is alien,
•iinr] therefore irritating, and among others to the brain : add to
u hich, that the long existence of irritation in the liver had al.
ready maintained a sympathetic one in the brain ; so that this
last becomes at length the seat of irregular circulation and apo^

120 DISOftDBBS OW THS LIVES AND BVOOIHini.

plexy closes the career of many a bilious patient. Or, the pat-
sage of the blood from the lower limbs and the viscera of the abdo-
men through the liver being impeded, the blood-vessels of those
parts become gorged by the gravitation of their contents ; and, to
relieve themselves, pour out their watery parts, and thus dropsy
of the abdomen and legs takes other bilious persons off. Or again,
the retention of the elements of the bile in the circulation, entail-
ing the office of their elimination on some other organ, the kid-^
. neys in this manner become diseased, refuse their office, and thus
dropsy of the head, chest, — universal dropsy in short, — kills the
patient by apoplexy or suffocation. Or finally » the want of bile,
added to the wretched state of the stomach which attends it, so
deteriorates the blood-making process, that the body sinks from
mere atrophy, the elements waste it, and it goes out, as a candle
deprived of air.

I have been speaking of liver disease as it originates from irri-
tations applied to it through the medium of the stomach. But it
may be well to mention another mode in which it may originate.
When, from organic disease of the heart, the passage of the mass
of blood from the liver upwards through it is impeded, that blood
returns upon the liver, is retained there, and produces all the
evils that congestion or irritation of its tissue entails. This, of
course, is a case quite out of the reach of any remedial measures.

There is another condition in which the liver fails to secrete bile,
which has no immediate reference to irritation of the organ — ^I
allude to the state of ancRmia, or bloodlessness. When from any
cause the body has been drained of its nutritive liquid, and all
the functions languish in consequence, the liver shares, of course,
in the deficiency : deficient blood is here the cause of deficient
bile. How, then, can urging of the liver with mercurials be
justified in such a case ?* Yet it is very commonly done, to the
further draining of the body and wasting of the patient, the want
^f bile increasing with the means taken to produce it. The folly
and superfiuousness of the proceeding is the more flagrant here,

• A medical acquaintance, in a state of exhaustion, complained of this
to me on one occasion, and told me he could not get bile, take blue pill as
he would. I referred him to his bloodless skin and thready pulse, and
asked where the blood was whence the bile was to come ? This had never
occurred to him, and astonished him much. However, he came to agree
^ith me, that digested mutton chops were, in his case, much ntoro oitft*
UliouB than the blue mercurial.

IIVS0BDBK8 OF THK UVBS AND DUOSBMUX* UHj

M there is not one symptom of biliousness, save the nan-appear«
ance of bile in the evacuations.

Much of what has been said concerning the liver, applies to the
thronic infiamnuUioH of Ihe dwodenum. There are the same
derangements of the biliary secretion, at first excessive, afterwards
deficient, but always more or less vitiated, — ^the same sympathetic
pains of the head and right shoulders, the same disorders about
the lower bowel, the irritability or indifference of mind, &c., &c.»
according to the phase of the irritation which obtains in the differr
ent degrees of liver disease. In fact, the duodenum is at once the
exit from the stomach and the entrance to the liver, whose .great
duct, down which all the bile pours, empties itself into it. Irrita-
tion applied to the orifice of that duct is like the same applied to
the throat : irritate the throat with a feather, and you sicken the
stomach ; inflame the mouth of a gall-duct at the duodenum,
and you excite the liver on its minutest secreting extremities.
There are a few symptoms, however, which mark this disease as
distinguished from liver disease alone. L Some time — generally
about two hours and a half — after a meal there is nausea or actual
vomiting : this is due to the passage of the first chime through
the inflamed duodenum into the small bowels : being the exit
from the stomach, the excitement produced in the morbid part by
this passage, throws the stomach ii to a state of convulsive action.
2. Again, the mental irritation from duodenitis ^ before* it has
caused biliary congestion, is extreme, and incessant : the fiend of
quarrelsomeness seems to have entered the patient, and taken
possession of him : his mind is one universal sore. The first
years of Napoi<eon's residence at St. Helena gave abundant
evidence of this .: he found insult and outrage in everything.

« A bust denied, a book refused, could break
The sleep of him who kept the world awake."

And all this time the slow process of duodenal irritation was
laying the foundation of those organic changes in itself, the
stomach and the liver, that were to lay him low — changes which,
I hesitate not to say, after a perusal of the details of his treatment
from beginning to end, were hastened, and all chance of avoiding
them removed, by that treatment. 3. At all stages of duodeniUe
there is more or less tenderness over the region of the organ, that
is, a little to the right of and below the pit of the stomach, and
deep down upon the spine : and as the disease proceeds, a di9«
7

Its DIS0RBXB8 OF THE UVBX AND DVODBNITM.

linct feeling of a tumor is added to the tenderness, bespeaking
the gorging of the whole of this short bowel with blood, or even
its organic change. 4. The form of the faeces is peculiar, the
cylinder being very narrow and flattened, a peculiarity which
varies with the decrease or exasperation of the duodenal irritation^
as confirmed by the subsidence or increase of the other symptoms.
It would seem as if the disease in the upper bowel caused sympa-
thetic spasm, or tumefaction of the lower one. 5. The duodenal
cough is very striking, — especially to the drum of the ear, on which
it rings hard, sharp, shrill, yet deep. That it is duodenal may be
readily proved by pressing on the bowel in question, when the
cough will be instantly produced.

Strange, that this frequent, formidable, intractable disease,
should pass unnoticed by so many English medical authors. Yet
80 it is. You will seek in vain for it in our standard works on
Practice of Physic. The fact is, that it is constantly spoken of
and treated as liver disease : whereas I would rather undertake a
dozen cases of the latter than one of duodenitis^ so practical do I
hold the difference between them to be. It is possible by regulat-
ing the quality of the diet, &c., to afford the liver some rest ;
but for the duodenum there is no cessation of irritation : chyme,
mostly of a morbid kind, is passing through it eighteen out of the
twenty-four hours : its own malady excites the liver to pour out
bile, frequently of an acrid kind, into its diseased cavity : the
stomach, extended with food or air, or moving in the act of diges-
tion, draws it mechanically in one direction ; the vermicular
motion of the small bowels draws it in another ; and it lies
close down upon the hard, unyielding spine, with a weight of
superincumbent viscera above it ; so that very little opportunity
of self- restoration is given to it ; and it seems altogether unneces-
sary to decrease its chances of this by passing purgatives of all
kinds over its sore and irritable surface, as is commonly done.
But, as has been observed, the disease was scarcely known to
the English medical world until a very few years ago. The
French recognized it as an important malady twenty years since ;
and I was the first to give a detailed account of this and other
chronic maladies of the digestive surface, as delivered from the
lips of the great Broussais.* I believe th&t very many persons

• See my translation, with notes, of his " Lectares on General Pathology
and Therapeutics," in the " London Medical and Surgical Journal*"
1835-36, of which I was at that time co-editor.

ksosubbs op the uveb and mroiraanjx. tit

irho tireat thenijselves for disordered liver labor under this more
dangerous malady : I have found several who announced them-
selves as " liver patients," but proved to have chronic duodenitis.

Is chronic indammation of the duodenum curable ? The an-
swer is regulated as in disease of the liver : irritation, inflamma-
tion, congestion, and tumefaction of the organ are curable : not
so the enlargement and hardening of it. The two first stages
are coincident with ordinary biliousness, with excessive bile : the
two next with the vitiation and deficiency of bile, though not in-
variably : and the last with Utter stoppage of the bile, the waxy
lip, the bloodless, dropsical skin, and other signs of lapsing vitality
and arrested nutrition. The fatal terminations resemble those of
liver disease : in fact, dicodemtis kills by disorganizing the liver.

The TEEATMENT OF LIVER DISEASE and DUODENITIS varies wilh
the stages. Common biliousness, with bitter rising, &c., is best
treated by hot fomentations over the pit of the stomach and liver,
continued for an hour every night ; by the long sitz bath ; wet-
sheet rubbing ; and the compress over the regions just named,
changed every two or three hours. The quantity of water for
drinking should not be large, as much water rather excites the
liver ; only a small quantity at a time should be taken. The
food should be chiefly farinaceous, and sparingly given ; it should
be quite free from any fatty material ; milk should be avoided, as
the clot it makes in a bilious stomach is exceedingly solid ; the
exercise should be moderate, and the mind should avoid exciting
subjects and objects. The aim of all this is to reduce excessive
action, a state bordering on the acute, and for the most part con-
nected with a highly nervous disorder of the stomach. The fo-
mentations do it by drawing blood to the exterior opposite to the
irritated parts. The sitz bath acts by deriving blood from the
upper to the lower organs of the abdomen. The wet-sheet rub-
bing soothes, by taking the caloric from the nerves of the skin,
which is very irritable in the bilious state ; and by doing so, tends
to quiet the excitement of the brain, also attendant on that state.
The frequently changed compress produces a frequent revulsion
of blood to the surface, diminishing the febrile heat within. The
nervous condition of the digestive organs will not allow of large
draughts of water, both because their bulk is irritating, and be-
cause they especially excite the liver. Animal food being too
stimulating, and succulent vegetables being generative of strong
bile, the farinaceous are used as least exciting, both from the

IM vaotuns. or thb litae akb mraiMuniic.

i quantity of nutriment they contain, and their aliglit i
on the Uver : fatty matters having an eicceasiye action in the oori»
tri^ diifeetionk The sympathy between the brain and liver it
one of the stnHSgest in the body, and, as has been said, strong
passion b a very common cause of a bilious attack. Hence in
ofaronio iHliousness, the activity of the brain, as shown in great
amount oi exercise, and in the consideration of exciting subjects^
sliould be avoided.

.' 3ueh is tbe^tyk of water treatment in ordinary cases of chronic
hiUousness^ where the irritation is generally of a nervous character,
but sometimes also of the mucous kind, or where duodenal urita-
tipn prevails. Of course, variations of management occur with
digb^y varying indications ; such as great headache, when foot-
buihs are necessary, or great febrile heat, when the wet^sheet
packing will be necessary, dsc. With regard to this last named
remedy, I must state that I have not found it of good effect in the
general run of these cases, except in the instance just mentioned ;
it appears to augment the tendency to headache, to enfeeble the
he^, in fact ; the hot fomentations answer better, a tumbler of
water being sipped whilst they are going on. Scrofulous and
lapguid temperaments require modification of treatro^t also|
but such are rarely seen to suffer under this sort of liver com-
jdaint. The great point is to rest the nerves of animal and or.
ganio life, and genUy to aid them, by the appliances of the water
treatment*

But it is otherwise when the liver has reached the point of
torpid congestion, of obstructed function. The object, then, is tp
roiiise it, on the one hand, and to effect a powerful diversion in its
&vor, on the other ; taking care, meanwhile, that neither in doing
the former, nor in rousing other organs in the iBXt&r, febrile ex.
citement be allowed to predominate. Excitement of a nervous
kind always attends more or less the successful treatment of this
case, for it is through the instrumentality of the nervous system
that the efibrts at self-restoration are made ; and this nervous ex-
citement produces phenomena of various kinds. Sometimes^
when, as a result of the water treatment, the obstructed liver
begins to be rotised to action, the patient experiences dyspeptic
symptoms such as he had not hitherto felt ; there is heartburn,
swelling after eating, extreme flatulence, even tenderness of the
pit of the stomach, — ^all indications that the organic nerves of the
digestive apparatus are laboring under unusual excitement, and

DTS01lt>BRS Of TAX LIVBB AND SVOSSmnl. OHO

iEhat the brain, too, is roused to a recognition of what is giAagom^
At other times, this last-named organ, the brain, becomes tteseat
of such phenomena of excitation, and the patient, whose torpid
liver had hitherto stupified his brain, and rendered him neariy
insensible to ever3rthing, finds himself nervous, aloKnt hysterical*
\y sensitive to every wind of circumstance. I shall spea]^ of this
more at length in the Succeeding part ; it is alluded to bees in
order to explain the difficulties which attend the treatment of con-
gested liver, and the necessity now and then of varying i^ and
sometjmes suspending it for a period.

Another consideration attaching to the treatment of o p ngea te d
liver is the presence or absence of duodenal irritation, and, if
present, of its character and duration. If coeval with, or snteoe-
dent to, the liver derangement, the same treatment may be ibl.
lowed foT both. If it is of more recent commencement (and
sometimes dttodeniUs succeeds, mstead of preceding, liver dia^use),
and therefore in the active inflammatory stage, modifioation of
the plan against the liver becomes necessary.

A third consideration is the condition of the brain as regafds
apoplectic fulness ; and this is a very disagreeable complication
to deal with, retarding, as it does, the active treatment necessary
for the reduction of biliary congestion.

Congestion is the stage of liver complaint which is by DIr/ibe
most frequently presented for treatment by the wat^r cure, the
patients having passed through the previous stages, and been
hastened towards this by the medicinal means I have already
mentioned, before coming to Malvern. The ^treatment com-
mences well with a day or two of wet-sheet rubbing, in order to
excite and prepare the torpid skin. After this, if there be
duodenal irritation of recent origin, it is well to pack in the wet
sheet each morning, and to foment with hot water each night fol
a short time, until the tenderness over that organ, and the 6ther
signs of its active disorder, be subdued. From the commence,
ment, however, there should be excitation of the skin with the
sheet-bath three or four times a-day ; and the abdominal com-
press should be worn, and frequently changed, day and night.
Water should also be copiously drunk, beginning with six or
seven, and getting on to ten or twelve tumblers daily. In veiy
old cases, much more than this is required, and a good part of it
should be taken before breakfast. In the majority of cases, this
preparation with wet^sheet packing is not requisite for more than

'HO .OI80RDBSS OP THB LIVBB AlID DtTODBllim.

m few days, in order to carry off some trifling feverishness of
action, the result, mostly, of the late irritating medication and
diet to which the patient has been subjected ; and the temporary
relief it affords is great. But to continue it would be injudicious,
as it is a lowering rather than a rousing process, reducing the
activity of the nervous and circulating systeins. Sweating is the
natural relief of congested liver; and as the principle of the
water treatment is to imitate and aid nature, that process of the
treatment should be employed so soon as all considerations regard-
ing the duodenum and head are removed. For this congestion
and torpor of the liver is very often accompanied by tendency to,
if not actual apoplectic fulness of the brain ; in which case, also
preparation for the sweating must be made by the wet sheet,
fomentations, low diet, and only a sparing quantity of water to
drink. The pulse and other signs evincing a safe state of the
.head, we proceed to sweat the patient every day, or every second
day, according to the powers of the brain and circulation to bear
it ; it must not be allowed to excite either to excess ; and it is the
physician's part to watch this well.- Giddiness and tension of
head, and palpitation of heart, require temporary suspension
of the sweating and water drinking. Slight accessions of fever-
ishness may be produced by the treatment, and these are to be
quelled by a wet sheet or two, and by fomentations. All this
time, the sitz bath should be taken in its derivative character, for
twenty, thirty, or forty minutes, once or twice a day. Passing
headache is to be met with foot baths, &c., &c. Thus the treat-
ment goes on ; and in the course of a period varying in different
Individuals, the douche is added, and gradually carried to the
extent of six or eight minutes. The abdominal compress is worn
day and night; a considerable quantity of dry friction with
brushes, &c., should be used over the limbs and abdomen af%er
each process.

The diet in hepatic congestion should, as a general rule, be
devoid of fatty and spicy materials, because, although such
things stimulate the liver, the object of cure is to make it act with-
out such temporary expedients of stimulation. A little more
latitude in taking of vegetable matters may be allowed; cauli-
flower, young peas, and Jerusalem artichoke being admitted, in
addition to the farinacese. But as in the former phase of liver
disease, hvik must be avoided ; therefore, if some farinaceous
pudding be taken after meat, both must be eaten sparingly.

DISOBDERS OP TB£ LIVEB AND DUODENUM. 137

For the rest, paste in any shape, fried meats or vegetables, duck,
goose, and twice-cooked food, are inadmissible. Hot liquid and
milk are bad ; still, upon the whole, the rules of diet are not ex-
ceedingly stringent as to quantity in this malady, and therefore
the rule as to exercise is to walk as much as possible, short of
feeling fatigue at the pit of the stomach. Even violent exertion
is good, the aim being to relieve the swollen torpor of an internal
solid organ, and this being assisted much by expediting the whole
circulation of the body.

Indeed, such is the aim of the entire treatment. The sweat*
ing botT) causes a diversion in favor of the liver and quickens the
circu]:ition through it. The douche does the like, vehemently
rousing the activity of the heart and exciting the skin. The
long sitz bath draws blood down from the upper organs of diges-
tion, and necessitates a long and brisk walk afler it ; the dry
frictions are artificial exercise as regards the circulation. Last,
not least, come the large doses of water, the effect of which is to
hasten those changes of the vital chemistry which shall both
quicken the circulation of the blood and change its mass, render-
ing it more fit for the secretion of healthy digestive liquids.

The crisis of the first phase of chronic hepatic disorder is
most commonly bilious vomiting or diarrhoea, or both ; sometimes
slight and long continued, at others, sudden and great. Glutin-
ous and ill. smelling sweatings at night not unfrequently accom-
pany this signal of relief in the liver. Of the swollen liver, the
common crisis is of boils, occasionally over the region of the liver
itself: gentle but continued, purgation of the bowels attending
. them. But both may go off with very large faecal evacuations
only, diseased in character at first, but gradually improving ; not
at all loose in consistence, but small in calibre at first, and gra-
dually augmenting in cylindrical volume.

The palliation — for cure is out of the question- — of the enlarged
and hardened liver consists in artificial sweating, repeated as fre-
quently as the head will allow, a great amount of dry friction of
the whole body, and copious water drinking. It is wonderful
how much the sweating relieves for a time. Under its influence,
1 have seen a hard and contracted liver afford signs of some slight
secretion in the fsecal matter, which the same sweating very often
causes the bowels to secrete and excrete. This retards the cer-
tainly fatal termination of this form of organic liver disease, and
keeps off some hsrassing symptoms^ Beyond this, it is impossiUo

138 DI80EDBB8 OF THB LIVSB AHB 0001001101.

to proceed, whatever enthusiastio writers on the water-cut^
assert.

Cass VI. — ^Nebyotts Disobdsb or thb Liveb.

A midffle-aged gentleman, who, fifteen years before, had been subjected
to two severe courses of mercury, for a syphititic aflfection, had, since
tiiat time, been a prey to a train of bilioas symptoms, generally exa»«
perated once in two <xt three weeks into the form of intense headache,
which prostrated him for two or three days. The ordinary signs changed
freqnendy in degree, and now and then left him altogether for twelve or
eighteen hoars, or, at least, were so slight, comparatively, as tiot to be
complained of. Great appetite, especially for such improper things as
the burnt part of meat, fat, &.C., considerable tlurst, clear, fiery-red tongue,
bitter taste, foul breath, sore throat, heartburn, acid and bitter risings,
tenderness of th? pit of the stomach, irregular bowels, varying urine, dry
hot skin, especially of the palms of the hands, florid complexion, red nose,
emaciation, sleeplessness, and great irritability of temper, — these left no
doubt of the existence of chronic nervous irritation tf the liver. The re-
mission of more or fewer of the symptoms, and the exaggeration of them
aU, from time to time, in the intense headache, which itself terminated
in bilious vomiting, came in confirmation of the nervous character of the
malady. Moreover, as is usually the case, the signs of dyspepsia at-
tended ; that form of dyspepsia which is so frequent a result of mercurial
medicines. He had had these disagreeables to some extent for fifteen
years, but for the last four years, they had become so intense as to dis-
able him from business, from which he had been, accordingly, oUiged to
withdraw.

Nightly fomentations of the abdomen with hot water, wet-sheet rub-
bings twice a day, a sitz bath of half an hour once a day, the use of the
compress frequently changed, and about six tumblers of water daily, con-
stituted the active treatment for nearly three weeks. The food was con-
fined to the farinaceaB and bread, the latter being eaten with very little
butter. Exercise was limited to half an hour three times a day. The
effect of this became very evident in the paling and shrinking t)f the face,
the reduction of the sore throat, the diminution of appetite and thu^t, and
the improvement of the sleep and temper — the latter nol much, however.
Besides which, no violent headache had supervened ; and the patient,
though feeling himself weaker, felt himself quieter. The fomentations
were continued, the cold shallow bath in the morning was substituted
for the rubbing-sheet, and in place of anything else, two long sitz baths
were taken. I advised him to try to take more water, and improved the
diet by the addition of some meat at dinner every second day. Exercise
was augmented. By these means, the bowels were made to act more
regularly, the bile always appearing in them, instead of capriciousdy, as
faeretoffne^ Desirous to bring all the anti-irritative means of the water

01SOBBBR8 OF THB LIVBB ANO DUOPBNUll. ISRI

t'lo i^y, I tried tbe wet-sheet packing, bnt it produced ooe tf
Umiviflleiit heediiehes, Mowed by copious vomiting of bile, wbic^ tboi^gii
it. left the patient better, so disheartened him, that I did not again give
itibutitried the towel packing in front This suited very well, and as-
sisted the fomentations in reducing the nervous irritation of the liver.
With these two remedies for sedatives, with the sitz baths for derivativea,
the diet regulated so as to oppress the stomach and escite the liver as
little as p08sible> the water drinking to cool the stomach and dilute its
contents, the ccHopress to counteract and soothe the irritated nervep
within^ and the exercise sufficient to waste the food and prevent repb-
.tion without straiiungthe nervous systemi this patient, in the course of
Jbnr months, recovered a state of health to which he had been a stranger
for neariy fifteen years. During the treatoient, he had only one head-
ache, induced by ^ wet-sheet packing ; and since he left Malvern, now
thirteen months, he has only experienced slight headache on two occa-
moDB, once after four glasses of wine (probably of a bad kind), and an-
oUier time in a hot room. Whilst here^ under active treatment, he had,
several times for several days together, risings of mouthfuls of bile, and
also days of turbid urine loaded with salts : bnt except these, he testified
no critical action, and the disease seemed to disappear by a simple altera-
tion of the nervous influence communicated to the liver.

This is an illustration of the ordinary << biliousness" for which
such amazing quantities of mercurials, tonics, alkalies, greasy
food, dec, are administered for. successive years, without the
smallest amelioration, but with the greatest deterioration, of the
symptoms. Gradually, the redness of the face grows more dim
and dingy, becomes mixed with yellow, the tongue endues a coat,
fixed pain in the right side supervenes, the appetite fails, dec, all
signifying that the liver is more deeply implicated, and that
mucous disorder, congestion, swelling of its substance, have taken
place. Here is a case in exemplification of this.

Case VU. — Cohosst£d ani) Swolleh Livbb.

A lady, fifty-five years of age, of a highly nervous, anxious mind and
bUiouB constitut^pn, became sufficiently disordered in her digestive pow-
ers to need m^ical advice, about three years ago. She was treated
secundum ariem for bilious dyspepsia, but went from bad to worse. From
being a plump, ruddy-faced person, she became puffy and deeply yellow.
A swelling under the right ribs was detected by the medical attendant ;
appetite was gone ; nausea incessant ; bowels utterly sealed, save under
the action of a strong aperient ; urine exceedingly scanty, and actually
thickened with a load of salts, urea, and bile, in color and consistsnca
Mng Hke a large quantity of dark day suspended in a small quantity gt
7*

'180 'msoRiiERS or tbb juvsb and mroiiBinni.

water; inoessant fever, dtc The best London and provincial li lted
only suggested fresh mercurials, which were introdaced profiisely bolli
by the stomach and skin, with the only eflfect of angmenting the tame*
&cti(m of the liver, arresting the process of digestion, and prostrating the
animal powers.

When she came to Malvern, she was under Dr. Wilson's care, and
continued so for nearly two months ; during which time, as I was told,
the wet>«heet packing was the principal remedy employed, ^e did not
flourish under it ; on the contrary, it produced violent disorder of the
nervous and circulating, as well as the digestive systems, evidenced by
sleeplessness, terrors, faintjngs, vehement flushing and palpitatians, and
incessant nausea. And this I have constantly observed in tumefied and
obstructed liver ; a very small amount of wetrsheeting is tolerable, only
sufficient to reduce some feverish irritation which sometimes exists at
the outset of the treatment, when patients ccMne with the effects of stimu-
lating medicines and diet fresh upcm them. This overcome, further
wet sheeting is harmful. The patient was in the disorder I have stated
when she placed herself under my care at the desire of hw s<m, who is
a physician ; and I accordingly undertook the case myself. Viewing it
at once as one of obstructed wad oppressed functi<m, I saw the necessity
of abandoning the lowering process of the wet sheet, and adopting that
which would cause a transfer of irritation, and thus bring about a diver-
sion in £Eivor of the oppressed liver. This was to be efl^ted by the
sweating process, which was practised in her case with the spirit-lamp,
the long imprisonment in blankets rendering her nervous. Further, as
there was a good d^ of duodenal irritation, and as after the rousing
process of sweating, and the unavoidable fatigue of digestion, noise, &c.,
during the day, some nervous congestion took place in the ganglions
about the stomach (the invariable result of animal and organic fatigue),
I directed a short fomentation with hot water to be applied every night
over that region. Alter the sweating, she was rubbed with dripping
towels. She wore the compress constantly. She drank freely of water,
but in small quantities at once, as flatulence and spasm were easily ex-
cited. Her food was farinaceous for the first few weeks, very carefully
given, and as carefully and gradually improved to animal liquid, and then
solid diet ; on this score, the utmost nicety was required. Last, not
least, the recumbent posture in bed was strictiy enjoined.

Had this lady not been previously exhausted, and rendered exceedingly
nervous by the medicinal treatment and the wet sheeting she had under-
gone, I should have hesitated to enjoin perfect inaction in a case of ob>
structed function. As it was, the smallest exertion of the brain sent
additional irritation and afflux of blood to the digestive organs ; so much
80, that, as I have said, even the unavoidable excitation of that organ by
sweating, the trifling noises about her, and some talking, caused such
afflux towards the ilose of each day, and.demanded fomentation. Reel
of the hmu and spinal cord, tbeie£ore, withdrew a source of initatto

mSORDBRS OF THB UVBR AND DUODSNITK. 181

from the morbid orgaoB; then the sweating transferred irritatioii
to the universal skin. The compress did the same contmnonsly ov«r
the digestive organs. The nightly fomentations, by dispersing the daily
congestion at the pit of the stomach, allowed the brain to go to sleep.
The water cooled and diluted the contents of the stomach, assisting also
the action of the bowels and of the kidneys. The food, from its mild and
slightly nutritious character, gave the digestives but little, to do. And
thus, in every way, opportunity was given for the oppressed organs to
recover their action.

This they gradually did, efieoting for themselves, when thus (daced in
a favorable position, what all the mercurials had been unable Xoforc*
diem to do. By degrees, the urine altered in quality and quantity, until
the first was perfect and the last great. By degrees, too, the imcxl eva-
cuations ^augmented in cylindrical calibre, in quantity, and from perfect
whiteness, became healthily colored. Then, after some weeks, sponta-
neous sweating came on, and continued profusely each night for two or
three weeks. And, as all this was going on, the knotty surfieuse of tho
liver, and then its size (which reached to the right hip and to the navel),
diminished in proportion ; so that at the end of seven weeks, she waa
seated in the drawing-room, and three weeks afterwards was driving out
daily. Meantime, also, her appetite and digestive powers had amazingly
increased, and the meat she took once daily, and the farinaceous food she
had in good quantity, were digested without the smallest inconvenience.
From an early date of the sweating, too, the complexion and the eyes,
which were actually of a mahogany color, so charged was the skin widi
bile, had commenced to resume their respective wliite and ruddy colors.
The sleep, with very few variations, was good, and the spirits excellent

I have given the general treatment adopted ; but it must not be sup-
posed that no modification, or even suspension, of it took place all this
time. On the contrary, from time to time, the sweating was reduced to
twice a week ; and on one occasion altogether suspended for a fortnight :
this was the period when the spontaneous perspirations were going on at
night, and which were, in fact, critical. Nervous headaches appeared
now and then, requiring the foot bath ; and the occasional dryness of
the mouth demanded increased fomentation and water, and decreased
animal food. But when the patient was enabled to go out daily, and te
walk for a short time together, the tonic part of the water treatment waa
applied more freely ; she took a cold sitz bath for ten minutes twice a
day, and the shallow bath on rising, and at bed-time ; the sweating being
reduced to twice a day. Under this rigime, she gained strength and
flesh, and at the end of three months firom the time of her coming under
my care, she was enabled to travel upwards of a hundred miles to the
sea coast, where she remained for three months longer, pursuing the
■ame treatment as nearly as possible. At the present moment, it cannot
be said that the liver is reduced to its natural limits, but it is gradually
trading towaxda it ; and in the meantin>ft> the patxuAf whose ^<mum had

IS9 P180BDBB« or TBI LIVEB AND DfJODBlfirM.

bMn regarded by her previous medical attendants aa neeeaaarily filial, la
liilly restored to the duties of her position, as the wife of a zeatons cler-
gyman, whose coadjutcMT she is in his <^ces to he poor of his pariah,
and as the mother of a large fiunily.

An illustration of another form which obstructed liver takes is
given in the following case : —

Case VIII. — Obstructed Liver.

After many years of service in the East and West Indies, the subjea
of this case, a military officer, returned to Europe, as many do, with io-
veterate dyspepsia and a gorged liver. This last was exhibited in a
mixed pallor and yellowness of the skin, eyes, the very blood-vessels of .
which were orange-colored ; lips, that were in places of a dirty red ; in
others, resembling hard wax-candle. The limbs were shrunk, the abdo-
men enlarged. In the state of the bowels, feelings after eating, bitter
taste, &c., the 83rmptoois were those of ordinary biliousness. But the
brain and nervous signs demanded more particular attention, as they in-
dicated pressure in the head. The sight was tormented with never- '
ceasing black spots, with occasional and momentary extinction, accom-
panied by giddiness. Hissing, clanging, and humming noises invaded
the ears. In the skull itself, dull headache alternated with feelings of
tightness ; or, on the other hand, of bursting extension. Sleep fre-
quently stole on him in the day, and was very deep at night, but molested
by dreams. His will was almost extinguished ; left to himself, he would
never stir from his Chair, and scarcely from his bed. His mind would
have fallen into \he same listless state, had not pain and temporary alarm
at the giddiness roused it every now and then ; although occasionally a fit
of almost insane irritability would blaze up for a few hours. The pulse
was generally hard, slow, and laboring, but would sometimes become
quick, simultaneously with palpitation of the heart, and also with the irri-
tation of temper. He had neuralgic pains in various parts of the body, but
more especially in the right arm, down to the fingers' ends. Dull, heavy,
but at times also acute pain occupied the region of the liver, which was
somewhat, though not much, larger than natural ; it was, however, very
hard to the feeUng. There was enlargement of the duodenum, but very
ittle tenderness on pressure. There were large hemorrhoids, but they
did not bleed.

All these symptoms showed two principal points of disease intimately
connected — ^the liver and brain. The latter, in fact, was threatened
with apoplectic seizure, to be followed, probably, by paralysis. But as,
in the body at large, there was rather a deficiency than a redundancy
of blood, it was plain that the flow towards the head was the result of
the strong morbid sympathy with the liver, and that active lowering
neasures, to any great extent, were not indicated. From the occasion*
•By acute pains of the Uver and excited state of the iQind, it also i^

X)ISt)BDER8 OF THE LIVSR AND DUODSNUM. 19S

peared that an fnterlnde of active Inflammation occurred in the ebronie-
ally inflamed liver, corresponding with increased excitement of the
circulation in the brain, and of the temper. The tic pains showed the
continnons organic irritation of the spinal cord ; and the pOes were evi-
dences of the obstruction oflered by the cpngested liver to the free
passage of blood from the contents of the abdomen to the heart.

In treating this case, it was essential, in the first place, to remove all
fear on the score of the head ; and the means to do this were fortunately
those adapted for the reduction of the tendency to the occasional acute
inflammation in the liver and duodenum. They consisted in hot fomen-
tations over the stomach and liver nightly, in wet-sheet packing every
morning, a cold cloth being kept round the head the while, in the con-
stant wearing and frequent changing of the compress, the reduction of
diet to the least stimulating farinaceous materials, and the reduction of
the time for sleeping. Very littie water was given. In the course of a
month, these means had produced the desired result, as far as the soften-
ing of the pulse, the steadiness of head, the diminished sleepiness,
and calmer temper went. Neither had there been any acute exaspera-
tion of the chronic disease of the liver and duodenum, which still, how-
ever, gave a dull pain. The kidneys, previously inactive, now acted
largely ; which was, no doubt, a diversion in £a,vor of the brain. Alto-
gether, in a few days beyond the first month, there existed no reason in
the head symptoms against a more direct attack on the chronic conges-
tion and obstruction, which constituted tiie main disorder. I therefore
had the patient sweated daily, taking care to have a cold cloth round hia
head whilst it was going on. Every fourth day, packing in the wet
sheet took the place of the sweating, in order to obviate any tendency
towards the head which might have increased. With a cq]d cloth round
the head, the patient also took two sitz baths daily of half an hour each.
He was made to walk from ten to twelve miles daily. Animal food was
given him every other day. The quantity of water he drank was appor>
tioned in strict accordance with the condition of the head, and, as fear
for it diminished, the water was increased, until at length it reached
from twelve to fifteen tumblers daily.

Such is an outiine of the treatment a^Dpted, and the reasons for it,
which the result justified. The constant diversion from the liver to-
wards the skin by the sweating ; the constant action of the copious water
drinking on the liver, on the digestive canal generally, and on the
kidneys ; ^e daily withdrawal of blood from the upper organs of diges-
tion towards the lower by the sitz baths ; added to the stimulus given to
the whole circulation by the great exercise, ihade this patient a new-
looking man in the course of nearly four months from the commence-
ment of the treatment. At that time, a great deal of constitutional dis-
turbance took place— sleeplessness, want of appetite, &c., all which waa
explained in a few days by the appearance of three boils in different
parU of the right side of the body, which lmm«diately took «way the

IM maoBDBfts of tbb liveb aio) dvodbnum.

distarbance, and brought about a better state of the fiver, as regaided
pain. Still, the tic paina in various parts remained ; and it was plain
that a good deal of congestive disorder of the liver still pfevailed.
After suspending the greater part of the treatment, therefore, for ten
days, until the boils had emptied, I recommenced the sweating everf
other day, ordered the douche for two or three minutes daily ; the two
sitz baths as before ; the diet improved into daily animal food ; the water
and exercise as before. After three weeks of this brisk treatment, the
piles began to bleed freely, and continued to do so, more or less, daily,
for a fortnight. The eflect on the tic pains was immediate ; and all the
black spots in the vision, the noises of head, &c., disappeared altogetherw
Thus, after having these two crises — boils and bleeding hemorrhoids-^
the patient had only left behind some nervousness of stomach, which
required care as to the quantity of food taken-— care which he must be
content to exercise for the remainder of his life, fortunate in having
escaped apoplexy, with years, probably, of paralysed helplessness. He
can now walk with any one, does with very little sleep, has a clear head,
a clean tongue, and a temper which is not bilious.

At this point, I terminate the subject of the chronic diseases of
the primary digestive organs. There are several diseases involv-
ing those organs which I do not mention, although I have had
experience of their treatment by the hygienic water plan. Cases
offoaier brash, of gastralgia, or tic of the stomach, of chronic heart-
hum, have follen under my notice, and been successfully treated.
But they are only modifications of the conditions which constitute
nervous and mucous dyspepsia ; there is still the chronic irritation
of the nervous or mucous texture, in the phases which produce
respectively excessive secretion of mucus, nerve-pain, or spasm
of the stomach ; and to treat of each at length would be book-
making. As it is, I have depicted the chief traits of the chronlo
disorders of the organs in qliestion with reference to the practical
differences between them in the treatment ; and under one or
other of the heads thus formed, all minor dyspeptic disorders will
range. Nevertheless, every one must expect to mee^ cases in
which the symptoms of nervous and mucous indigestion, and of
irritative and congestive, liver disease, are so commingled as to
defy arrangement, and to require the greatest discriminative and
practical tact on the part of the physician. Into such cases it ia
impossible to enter in print, the signs by which they are dlstin-
guisiiable being far top numerous and minute for written enixxtkp

SIBOX2UBB9 or THB LIVEB AJND DUODBIOIIC. UB

ratioD. By having a clear idea of what constitutes nervous
dyspepsia, as distinguished from mucous dyspepsia, and of irrita-
tive liver disease, as distinguished from congestive disorder, it
becomes more easy to detect, in a mixed and complicated case,
how far the elements of any of those states predominate, and to
practise accordingly. For this reason, also, I have given cases
in illustration of each, which are of a grave, and, one or two,
almost desperate character : the differences are thus shown more
prominently. Happily, such serious instances of digestive disease
are not of very ordinary occurrence ; but inasmuch as the watei
treatment is able for the cure of such, it is certain, on the logical
principle that the major includes the minor, that it is adapted for
the cure of less serious, though perhaps as tedious cases-— cases
80 tedious, indeed, that it would be a serious undertaking to write
or read them. We therefore pass on.

IM XUSSASm 07 TBB BBOOXfBAXT HU T KI T iVK 0MAN8.

CHAPTER II.

DISEASES OF THE SECONDARY NUTRITIVE ORGANS-DIS*
EASES OF THE LUNGS AND HEART.

Rfttionale of the Secondary Process of Natrttioii ia the Chest^Diseues of
the Chest in which the Water Treatment is not Curative — Nenrous
Cough — Stomach Cough — Chronic Inflammation of the Air Tubes —
Chronic Bronchitis— Pulmonary Consumption, incipient and confirmed—^
Palpitation of the Heart — Organic Disease of the Heart

As changes in the nutrition of parts are the bases of all diseased
actions, it is physiologically correct to treat of them in the order
of the organs which minister to nutrition. Natural as this plaa
is, I am not Aware of any medical writer who has proceeded on
it ; probably (among British authors especially), because the act
of nutrition has been but little thought of, and still less has the
sympathy between that act at the extremity of the body, and the
same at the great centre of the stomach, been sufficiently recog*
nized. But it is my desire to exhibit this sympathy in the strongest
light, and I cannot do so more effectually than by treating of dis-
eases in the train which nutrition takes.

Nutrition begins at the stomach ; there the first step is taken
in the formation of the nutritive liquid — ^the blood ; hence the
name of " primary nutritive organs " which I have given to the
stomach, and to the liver, its coadjutor. These cease where the
absorption of the crude blood, called chy',e, takes place-^namely,
at the small bowels. This chyle is carried up into the heart, and
projected thence to the lungs, where its exposure to the atmo-
sphere causes its transformation into fully elaborated blood, fit for
the nutrition of every tissue of the body. In the cheH, therefore,
the second part of the process of nutrition takes place ; and the
organs which effect this deserve the epithet of " secondary nutri-
tive," which I have given them.

The fact, which every day's experience of an observant physi-
cian must demonstrate, that the liability to disease, the tenacity
to disease^ and the curabUity of disease, in any part of the body^

.NEETOUS COITGH. 1S7

depends upon the healthy or unhealthy state of the primary nutri*
tive organs, has caused me to dwell at greater length on theii
maladies than it will be necessary to do on those of other organs.
In fact, many diseases of which I shall have occasion to treat are
merely symptoms of some phase of disorder in the digestive ap«
paratus, to which I shall have constantly to refer. Without this,
there is no sound view of disease ; every patient of chronic dia-
order confirms my conviction of this.

Not many chronic lung diseases admit of cure by the water
treatment. Considerable reUef is obtainable in cases of asthma^
which is connected with a nervous condition of the stomach, and
I have effected so much in three or four instances. But when
mucous and nervous dyspepsia, with, as not unfrequently happens,
disordered liver, are added to it, even relief is rare and small.
Cases of this kind, therefore, as well as ahy cases where the pa-
tient is past the fiftieth year, or where the disease has existed
more than five or six years, I consider unfit for treatment, and
am in the habit of declining to treat ; and I utterly disbelieve the
tales that have been printed about the cure of old asthma by the
water plan. Pulmonary consumption is, of course, incurable ;
but I shall offer a medical curiosity, in the shape of a case where
the water treatment decidedly prolonged the life of the patient, as,
indeed, I have seen it do in two other instances : besides that, by
reducing the hectic, and quieting the nervous system, it smoothes
the path to the inevitable grave. Senile bronchitis, or old man's
cough, is not a disease for water treatment. The bronchitis con-
nected with organic disease of the heart I have somewhat alleviated,
together with the irritability of the heart itself; but I apprehend
this is rare. I will proceed, however, to speak of that which is
within the scope of treatment.

§ 1. Nervous Cough. — Stomach Cough.

It has been already stated, that a sympathy exists between the
stomach and the lungs, by virtue both of the continuity of their
mucous surface and the prevalence of the same system of nerves
in each. This nervous connection renders the cause of stomach
caugh sufficiently obvious. Food irritating the digestive organ,
the branches of the ganglionic nerves convey the morbid organic
.^enaatiaa to the windpipe, where an irritation is also excited, which
puta the respiratory nerves and muscles into the convulsion of

vli8 STOMACH coua««

«oiigh. Hence stomach cough is so frequent after a meal. It is
not, however, requisite that food should enter the stomach ; cough
IS often present when that organ in empty. This is more especially
when the duodenum is the seat of chronic disease ; and when,
iherefore, the liver is more or less irritated. I have already re-
marked on this cough (fol. 22). This is the sort of cough which
spirit drinkers have, as well as they who use large quantities of
cayenne and other hot condiments. Moreover, acid secretions in an
empty stomach, or even flatulence, suffice to produce the sympathy
with the lungs. Nay, the long fasting of the stomach renders it
irritable, and thus induces cough. Hence the taking of water or
food sometimes stops such cough. When also spirit drinkers have
established a chronic irritation of the stomach, they, at first, are
incessantly clearing the. throat, save for a short time immediately-
after the renewed stimulus of the alcohol, which seems to dis-
perse the irritation for the time, only to make it worse afterwards ;
for, in the end, this clearing of the throat augments into a regular
cough, which also is subject to the same influence of alcohol, and ^
its withdrawal.

But further ; with the stomach in a state of irritation, mental
emotions often play an extraordinary part in exciting a cough :
but inasmuch as without such state of the ^omach, no cough is
thus caused, it is plain that the mental act tells first upon that
organ, and only mediately on the lungs. Surprise, anger, a pain-
full recollection will do this : and because they do so, the cough
has been called " nervous," whereas it, in truth, acknowledges
the same morbid origin as that called <^ stomach," and is to be
treated in a similar way. We shall afterwards trace this so-called
" nervous'* cough up to the consummation of pulmonary consump-
tion, the whole process and its mental excitant forming the too
frequent tragedy of a broken spirit and broken heart.

It is not often that chronic ne^ous or stomach cough is pre-
sented for treatment at Malvern : patients have for the most part
passed through it and attained a more deep seated and serious
implication of the lungs with digestive disorder. I have had,
however, three or four cases, and I select the worst of them to
illustrate the treatment.

Case IX. — Stomach Cough.

In this case the patient, a gentleman twenty-nine yeajns old, had m«
dnljged in the excessive nae of hot condiments, cayenne, mostiurd, hone*

STOMACH cotrcs. UO

TidiA, &c., and had for eome time past labored nnder nervous dyspepsta,
with a slight degree of mucous inflammation as well : a state which, be-
getting sinking, gnawing, and craving in the stomach, led to still larger
quantities of these dietetic stimulants. He was a man of vivid nervous
system and quick sensations (as, by the way, most people who desire
highly stimulating food are). When, therefore, in the midst of this dys-
peptic state a severe mental shock came on him, a train of nervous symp-
toms presently appeared. One of these was cough, which, as it persisted
for several months, notwithstanding a variety of treatment, began to be
dreaded by himself and his friends as an indication of serious mischief
in the lungs : and as other remedies had failed, water was tried, amid the
jeers and warnings of those interested in him.

It was fortunate for this youth that the cough had appeared : for I
found him on the high road to a most serious and inveterate dyspepsia,
which his mode of diet was daily augmenting. The mucous membrane
was inflamed in the stomach, and vividly at the back of the throat. The
breath was foul, as it generally is in stomach cough, the tonsils partaking
in the disorder. The cough was convulsive to the last degree, came in
long and frequent paroxysms, and left his head gorged and aching with
the retention of blood in it. There was not the slightest expectoration :
although occasionally the mechanical violence of the cough would abrade
the mucous surface of the organ of voice, and cause some blood to rise
into the mouth. The stethoscope gave no signs of disease of the air
tubes or spongy substance of the lungs. In short, it was clearly and in-
dubitably a stomach cough, which had been considerably exasperated by
the irritating medicines, antimony, squills, &.C., usually given for pure
lung coughs, for which it had been mistaken.

The result of the treatment soon showed what it was. The patient
was confined in his diet to farinaceous food, except a small quantity of
chicken every other day ; all condiments but salt and sugar were with-
drawn, as well as all warm liquids: the stomach and bowels were
fomented with hot water every night for an hour : he was packed in the
wot sheet every morning for the same time, with a cold shallow bath
after it : he wore the abdominal compress day and night : and he drank
seven or eight tumblers of water <Jaily. In ten days the cough was
gone, and has never since re-appeared, although, for want of time to give
to the cure of his stomach, the gentleman still remains dyspeptic, but to
a much less degree than formerly. For, he learned when at Malvern
that drug tonics do not always ^ive tone, that stimulating food does not
always nourish or strengthen, and that enough of plain nutriment and
pure water carry the body further in power than either. Therefore,
although he has not got rid of the old digestive sore, he has taken care
not to increase it.

It is not very often that a cough is allowed to be a stomach one
•«t all : and when it is> the medicinal applications generally allay

140 STOMACH cotn»R.

ft ibr the dme, and exasperate its cause in the ttemaoli m Hm
long, run. But so much is there in words, that ** cough'* being
pronounced, " lungs" are also uttered : they are joined together,
treated together, and not a thought is given to any other organ in
the body. Yet for want of this thought many a simple nervous
oough has become an irremediable bronchial, or a fatal tubercu-
lar one. The passage towards these two conditions will be seen
in the two following sections.

§ 2. Chbonig Inflammation of the Aib Tubes of thb Lumgs. —
Bronchitis.

Nervous or stomach cough would be too trivial a disorder to
dwell upon, were it not a sign of morbid sympathy established
between the digestive organs and the lungs. During a period
which varies much according to individual tendencies and some
accidental circumstances, the sympathy is only exhibited period-
ically, the cough coming and going without any " taking cold,"
but the dyspepsia always persisting. Almost imperceptibly the
patient becomes more susceptible of cold than heretofore : night
air, cold and damp air, change of clothing, &c., bring on cough
which is hard and dry at first, but afterward goes off with expec-
toration, and is accompanied with more or fewer of the usual
symptoms of taking cold. At this point the nerwms cough has
ceased^ and branchial inflammatory cough has commenced : the mu^
cous membrane of the air tubes is now implicated. The attacks in
question become more frequent and more prolonged ; for, not only-
does the extent of the bronchial mucous membrane involved in-
crease, but at each attack the part last affected becomes more
susceptible and less tractable : until at length the inflammatory
action creeping down the tubes takes permanent possession of
their lining membrane, and chronic bronchitis is establisAied.

While all this goes on the digestive symptoms have increased,
but are very commonly overlooked, as they were at the com-
mencement, so intent is the treatment on eradicating the cough.
Indeed, they are not only overlooked, but denied at the butset,
simply because the patient can eat, sometimes voraciously, as in
nervous indigestion : so coarse is the ordinary idea of that condi-
tion. Nevertheless, I maintain that bronchitis in a chronic form
is never established without the aid and concurrence of the stc»n-
■oh and other digestives. A man may take oold in the head ; it

THE AIS TOBBS OV THS LVNGS. 141

■ttj cfeep down into the chest, and thence drnpiiear #ith lex*
pectorBtion,-— it is an every day fact : but not if thei^ be stomaoh
disorder ; it then becomes chronic, relaxes with the relaxation of
the indigestion, and augments with its exasperation. The conse-
quence of acting on a denial of this is, that the remedies em«
ployed against the cough feed its maintaining cause in the stom-
achy and are thus actually increating the mischief for which they
are given. It is thus that after years of this worse than fruitless
medieatbn, the patient exhibits a complication of evils that is truly
appalling. Not only has he the immediate ills of dyspepsia and
bronchitis, but those arising indirectly from impeded digestion
and respiration. The former will be found in their proper place.
But the difficult breathing acts upon the head by preventing the
free return of blood downwards from it, whereby it become
gorged : this is seen in the puffy, turgid, and sometimes purple
faces of patients. In like manner it gorges the liver, by impeding
the return of blood upwards from the abdominal viscera through
that organ, and thus adds to the dyspeptic torments. Nor is this
all : this disorder of the liver leads to general abdominal congfes^
tion of ^blood, which either induces dropsy, or, the blood gravi-
tating to one particular spot, piles and disease of the rectum are
generated,^ — a cwnplication very oflen seen in old bronchial and
tubercular disorder of the lungs. Finally,, the accumulation of
mucus in the air passages prevents the free access of air to the
black blood exposed on their surfaces for the purpose of being
changed into arterial, vermilion blpod» fit for the healthy nutri-
tion of the body. That change is imperfectly effected, the nutri-
tion of the body is consequently imperfect also, and the functions
of the organs languish. The vis vita is .depressed : the re-active
energy is diminished : and in this state the skin, unable to resist
the agencies of cold, lets in the plagues of rheumatism and other
maladies dependent on alternations of temperature. Hence it is
that old coughs and old rheumatisms so oflen are found in the
same person. The mischief begins at the centre of nutrition, the
stomach, and travels to its periphery in the skin and limbs.

The facility of expectoration varies with the exasperation, or
otherwise, of the stomach irritation. This being roused by food, or,
what is very common in this malady, by mental agitations, the cough
immediately becomes more frequent and more dry, the breathing
more difficulty and what expectorated matter there is more stringy
md tenadotts. Under these cuoujmstaiices I hav0 repeatedly

143 GHftONlC nfFLAHNATlON OT

tasted the origin of these lung symptoms by applying fiwiontan
tions to the stomach only, when they invariably dissipated, whieh
they failed to do when the same remedy was applied over the
ribs. Besides, one has only to observe the acid breath and eruc-
tations of persons with old bronchitis, to be assured of the gastric
disorder that accompanies and varies it. I insist upon this fact»
because it is the ordinary practice to place the digestive organs
out of the question when lung disease is treated, and thus they
suffer from the negligence of diet and the activity of the expecto-
rants and other irritants given for the lungs : whereas all the
lungs require is withdrawal from exciting air and reduction of
the morbid sympathies transmitted to them from the stomach.
There may be one exception to this rule, when the hroncMUs is
connected with organic disease of the heart : but even then, who
ever saw organic disease of the heart without deranged digestion ?
nay, this last invariably precedes it. Still with diseased hearty
the bronchitis would continue even were it possible (which it is
not) to abolish the dyspepsia : the heart would be. maintaining
cause enough.

Several cases of chronic bronchitis have left my care cured :
but I prefer to give one, the symptoms of which were far worse
than any of them, and which though, as will appear, consider-
ably relieved and indeed arrested in its fatal career, is not now
nor ever will be totally cured, thanks to excessive medication.

Case X.,— <Jhronic Bronchitis —

Is one of a gentleman, forty-eight years of age, in very extensive
business in the city of London, and who, being highly esteemed by hiv
fellow-citizens, has had much to do in civic transactions. Between the
private and the public occupations, his stomach began to be disordered
eight or nine years ago. He acted as usual, took physic, worked on, broke
down again, physic again, and sO on. At length dry stomach cough
commenced, — ^the morbid sympathy of the digestive ganglionic nerves
had involved those of the windpipe. Cough medicines were given:
more stomach disorder, more cough. He took cold, as dyspeptics readily
do : acute bronchitis came on, was vigorously treated secundum artem^
and subdued : but, — and here is the point, — Shaving a bad stomach, it
was only subdued into a chronic form. This went from bad to worse,
notwithstanding a fearful quantity of doctoring, until the question arose
whether he would not be utterly incapacitated for business. He was
sent from home hidier and tiutbdr : and at length came to Malvern : —
Mt with the intention of trying the water tretttment, agaiasl wUeli h&^

THE AIU TUBES OF TB£ LtJIffGS. 143

liBil been specially warned. I saw him once, examined his state acen*
lately, and told him how the whole mischief had begun, progressed, and
would end, if not attacked at its source. That I should give him his his-
tory instead of receiving it, inspired him witli sufficient confidence to
brave the warnings of friends and physicians, and after a brief time
to arrange matters in London, he returned to Malvern, for water treat-
ment.

It was high time. Without sleep at night he passed the day in cough-
ing, wheezing, suflbcative breathing. He was the color of whity-brown
paper, emaciated, haggard, his shoulders raised and back rounded with
the efforts of laborious respiration. He had the ordinary signs of ner-
vous indigestion,- with flatulence of a most distressing kind : the appe-
tite generally good, bowels confined, kidneys acting very scantily. Skin
quite without moisture, except some cold damp when the respiration
was more than usually bad. Intense headache from frequent coughing
and impeded return of blood from th^'fiead. The stethoscope gave evi-
dence of bronchial inflammation in every quarter of the lungs, and, in
several parts, of enlargement of the air tubes. To use the expres-
sion of a medical friend who saw him with me, " there was not a sound
square inch in all his lungs."""

The treatment was simple and uniform. At first he was fomented
morning and evening, and rubbed with ^pid wet towels. He wore a
compress on the stomach, and drank a .claret glass of water frequently
in the day. By degrees I got him on to bear cold rubbing ; then he was
partially p'acl^d in a damp sheet ; then entirely so, except the feet. The
shallow bath afi«r sheet was taken at about 65^, sometimes higher, some-
times lower, as I fouiid his pulse and his general sensations. In diet, the
object was to avoid bulk ; he took meat and bread for dinner, and only breai^
at his other meals. Very little exercise was possible for some time, even
had it been desirable, which it was not ; he drove out occasionally, and sat

* The medical friend alluded to is a physician of great attainments and
practice in London. Visiting me for a few days, he, in the course of con-
versation about the water cure, of which he had seen nothing, told me I
«* dared not apply the wet sheet in lung disease." My reply was to take
him to see the subject of this case, who allowed him to examine his chest
(the result being the exclamation abdve), and goodnaturedly offered, as it
was near the time for his packing, to have it done before him. He cough-
ed before getting in, but assured my friend that it would cease in three or
four minutes after being packed ; which it did. Returning from this scene,
my friend asked me if packing in the sheet was good for an incipient cold.
I told him it would cut it short. " Then I will try it to-morrow morning,**
said he. It was done, presto, and not only dissipated his cold, but opened
his bowels, which had not acted for years without a daily pill. Upon this
I urged him to stay a fortnight, and continue it and the sitz bath daily.
H6<did 80, and has never talQsn nsdicine fog his bowels since If medical
«MHi.tvtmid but see belose thV assert !

144 cHRomc nfTLAiuiATioif or

in the air a good deal, it being summer time. By watching opportonl
ties and careful examinations, I was enabled to push the treatment up to
the point of his taking two wet«heet packings in succession every mor-
ning and evening, with the cold shallow bath after them. He also at^
tained to six and seven tumblers of water daily. He never could bear
the sitz bath, which I tried on several occasions, and at several tempera*
tures ; it always disagreed, bringing on paroxysm of indigestion and di&
ficult breathing ; so I desisted from it, the rather as the bowels, to pro*
mote whose action I had prescribed it, gave way and remained active
always afterwards. He was also very uncertain as regarded the com-
press ; at times it would not get warm, at others it became too warm»
and made him restless and nervous. Ever and anon fomentations with
hot water were necessary. All these small but really important points
of treatment being closely attended to, the main treatment, the wet sheet-
ing, prospered wonderfully. The fits of coughing diminished more than
one half in number, and much more than that in intensity. His face open*
ol: his spirits rose; his desire for and capability of walking augmented
daily; the indigestions were also much less frequent. There was
not much change in the treatment, except in its increase or decrease,
during the time he remained at Malvern ; and it would be endless to re*
late the circumstances that arose demanding slight alterations. At the
end of four months, this shattered frame, for which the grave was yawn-
ing before he left London, and which had been given up as hopeless of
relief, returned to London strong enough to engage (much against my
advice, however) in the old turmoil of public and pri^te business.
Since then, now two and a half years, he has persevered in the regimen, and
occasionally in the active treatment of the water cure, giving himself a wet
sheet or fomentations according to circumstances which I had indicated
CD him in writing. How he has fared since he left Malvern, and the
upinion he holds concerning his recovery, will be best gathered from the
foUowing extract from a letter which he wrote to me in August, 1845,
is answer to my inquiry whether it was true that he was ill again : —

** You are incorrectly informed as to my health. I assure you, since
my return I have been most decidedly better. I have been obliged to
attend very closely to business, but I am thankful to say I have been
enabled to do so.

'* I wish, for the benefit of others, that the water cure was more gene-
rally practised ; the more it is known, the sooner the prejudice that is
now kept up by interested persons would give place to confidence and
restoration of health to many who, like myself, have been the victims
of the drug system. I can, however, enter into the feelings of many ;
f<»r I myself treated the whole water system as a piece of humbug, and
joined in the laugh and ridicule which the mere mention of lying in a
wet sheet produced ; and when I first consulted you, at the urgent re-
quest of my brother and sister, who had derived great benefit, I was
told with much solemnity by my medical advieer heroi * that if I y

▲1& TUBES OF THE LUXfGS. 145

t

frt into a wet sheet I should not come oat alive.' Up to the time I left
Malvern for London I never missed one day (for some months prior)
taking medicine ; and you may perhaps remember I had three kinds
carefully prepared for my use, in tolerably large quantities, — one to pro-
duce sleep, one to relieve a most distressing cough, and the third to
give tone to the stomach and produce appetite, besides pills to act on
the bowels, which I was obliged every other day to take. At your re-
quest I * threw physic to the dogs,' and it is runo more than two years
since I ham taken a grain of any sort or kind of medicine. My general
health is veiy much better ; the compress at aU times produces the re-
quired relief of the bowels, and although my cough is not gone, it is far
less troublesome, and seldom disturbs me in the night. I had, as you
are aware, four wet sheets in the day, and always felt more reluctance
to leave their soothing influence tlian hesitation to envelope my self ;
though to the uninstructed the thought is most chilling.

" If I could detail the complication of ills under which I suffered,
the simple cure would not suffice for most people*; and if I can part
«(ith my cough I shall ever consider it the most fortunate circumstance
of my life that I was induced to place myself under your most judi-
cious and skilful treatment"

Truly this patient had << a complication of ills ;" and although
he has still some cough, because there is organic enlargement of
the air tube§, I have more pride in relating the partial restoration
of such a desperate case, than the total recovery of a dozen
^ordinary cases. It speaks volumes in favor of the water cure,
and has confirmed my faith in it more than any I have had.
Under the old medicinal plan, I must have done as the previous
medical adviser of this patient did, — ^give him up as hopeless.
The means were not in the Pharmacopoeia, and none can be
blamed for that. JNot the least pleasure derivable from the suc-
cess in this instance is, that a most estimable man and useful
member of society has been restored to the large sphere of his
utility.

Of bronchitis accompanying organic disease of the heart, I
have had three cases, in which the water treatment was decidedly
palliative. In these the partial wet-sheet packing was used, with
tepid ablution after it, and a compress was worn over the chest
night and day. I mention it here, both because it is a means of
smoothing the path of the doomed patient by diminishing the
harassing cough, and because I would record the perfect safety
of the application ; of which more in another section on heart

8

146 FtrLMOlfABY COSfSUMFTIOIf.

§ 8. Pulmonary CoNstrMrrioif.

Tuhercle, or tubercular matter, the inflammation, suppuration,
and ulceration of which constitute the different phases of pulmo
nary consumption, properly so called, is a morbid tissue, the
result of morbid nutrition. That nutrition dates from the stomach
and other digestive organs. Tubercle is never deposited unless
there has been, and is, disordered assimilation of food, imperfectly
formed blood as a consequence of that, and, besides these, sympa-
thetic irritation radiating from the centre ofnutrition to the lungs.
If there be not these conditions, persons may take cold, have in-
flammation of the lungs, which shall dissipate or end in abscess,
but they will not have tubercular deposit. There never yet was
tubercular deposit with a sound digestion. As in the case of bron-
chitis, this fact has a highly practical influence on the treatment
of persons who are suspected of a consumptive tendency. If the
condition of digestion is to be considered, it becomes a question,
how far it is judicious to coop those so situated in one or two hot
rooms during six or seven consecutive months; whether it is
desirable to send them to the malaria of Rome and the dyspeptic
clime of Italy generally ; and how far the system of high feeding
and tonic mineral waters is eflectual. Me judice, neither the
climate of coal-heated rooms, nor the scorching sun and freezing
tramontane of Italy, are at all adapted to overcome that infirmity
of the digestive organs which lays the foundation of tubercular
consumption ; neither on the vital nor the chemical theory of life
do we find in these means the remedies for the enfeebled power of
blood-making, whence the morbid deposit in the lungs is traceable.
And as regards the plan of high feeding, the " beef-steak and
porter" plan (which, by the way, acknowledges the deficient
vitality of the blood), it would be all very well if the stomach
could well digest the food — a question which is begged, but can
by no means be granted ; else what necessity were there for the
tonic minerals that have been by many declared the true remedioa
for the consumptive tendency, but which, in truth, only afiR)rd,
like all medicinal tonics, artificial and temporary energy to the
stomach, to be followed by augmented exhaustion ?

The two first of these means look only to the lungs, to the air
which they are to breathe ; the food and physic in the latter have
Inference to the stomach digestion only. Now, from what pre-
oedesi it is plain ^ ^t both require attention, and the way to regwtH

IPULMONAEY CONSUMPTION.

w

them is as two processes Df digestion ; one, of food in the stomach ;
the other, of atmospheric air in the lungs. A physician of tact
would give the stomach just so much as, and no more than, it
could transform into healthy chyle. He would also measure the
capabilities of the lungs to analyze or digest the air presented to
them ; and he would always bear in mind, that in each of these
organs there was a standing irritation, liable to be exasperated by
overworking of the function of either. Further, he would
endeavor, on the one hand, to diminish this irritation, and at the
same time to increase the extent, as well as improve the charac-
ter, of the digestion. Thus, he would keep down irritation in
both organs ; he would adapt the food and air to the power of
each, endeavoring to augment that power in both ; and as a
result, he would cause the production of a better blood, and have
it better distributed, instead of congesting in the two localities.
Suppose him to do all this, he will retard incipient consumption,
and postpone for some time the inevitably fatal event of confirmed
consumption. All medical men know that, so long as tubercle
remains uninflamed, it is harmless, and that it may remain so for
years; and the deposition of tubercle is synonymous with
incipient consumption.

Here is a case illustrative of the value of the water treatment,
in that process of gastric irritation which bears upon the lungs
with destructive tendency. On the one hand, the stomach irri-
tation arrests the monthly evacuation from the womb ; and, on
the other, radiates towards the lungs, being joined by the addi-
tional irritation proceeding from the stoppage of the evacuation
in question. Between the two, the lungs are pretty certain to
become consumptively diseased, if the original disorder be not
arrested, as it was in the following case. Even as it is, I strongly
suspect the presence of minute patches of tubercles in the lungs
of this patient ; but they are certainly not inflamed nor soflened ;
and, meantime, the process by which they are formed is nolongor
in action.

Case XI. — ^Thbeateking CoNsuMPiiti jJisobdeb of the Lxmos.—
Intense Stomach Ibeitation.

*The age of tbe poor woman in this case is thirty-two. She had
abundance of domestic troubles, privations, and incessant labor; the
consequence of which was exhibited, fifteen months ago, in the appear^
ance of gnawing ^t the stomach, distressini^ sinking sensation there, and

148 PULMONARY CONSUMPTION.

Btnmg palpitations of the heart. She had no appetite, but the craving
and sinking obliged her to be constantly putting something into the
stomach, which augmented the mischief. The bowels were in perfect
order. She fought, as she best could, against the disease for three months^
by which time the monthly evacuation had ceased. Upon this, and the
coming on of cough and profuse sweats, she went to an apothecary near
Worcester, who gave her drops, which, she says, " made me much worse.*'
However, she took drops and other physic for three months, when, find-
ing all her bad symptoms on the rapid increase, she quitted the apothecary,
and for two months allowed matters to go on as they would. Three
months over, she came to me for advice.

I found a pale, ghastly, and emaciated woman ; the skin constantly
bedewed with sweat, which at night streamed from her ; strength gpne ;
pulse small, sharp, and beating 125 in the minute ; the heart making
frequent and violent leaps in the chest ; breathing as short and bad as it
could be ; cough hard, dry, incessant ; tongue fiery red, clean, and swol-
len ; feet swollen, and pitting on pressure ; bowels right ; no menses for
more than nine months ; very little sleep. The old gnawing, craving,
and • sinking at the stomach were worse than ever. The stethoscope
showed very feeble respiratory power all over the lungs, and great indis-
tinctness of it in two places, at which spots I believe that tubercles exist
in a crude state.

I had a bad augury of this poor woman, and it was not with any great
expectation of benefit that I desired her to pursue the following treat-
ment : — To pack the trunk every morning in a towel wrung out of cold
water, for three-quarters of an hour ; to follow it with rubbing in the
dripping sheet, cold ; to take a cold sitz bath for a quarter of an hour
once a day ; to wear a compress over the stomach day and night ; and to
drink four tumblers of water daily. Her diet was restricted to bread and
butter, and farinaceous food of diflferent kinds. She has not tasted animal
food since she first saw me. She has continued this plan for nearly six
months, and has seen me three or four times in that space ; but, finding
her getting on well, I did not disturb the plan she was pursuing. The
sweatings were the first to diminish ; next, the gnawing and craving of
the stomach disappeared ; the cough is quite gone — not a vestige of it re-
maining; and during the last three months she has been steadily gaining
flesh. The breathing is strong enough to allow of her going well up a
hill, and the respiratory murmur given through the stethoscope is much
stronger. But in the former spots, where it was wanting, it is still de-
ficient ; and this confirms my belief that tubercular deposit exists there.
She is saved, however, from pulmonary consumption, which sooner or
later was inevitable, when such intense morbid sympathies were all fixing
on the lungs together.

I am not about to say that, in the water cure, the means exist
of curing either incipient or confirmed consumption ; such means

PULMONARY CONSUMPTION. 140

exist in no plan of treatment hitherto advanced ; but, looking tt
the aims just detailed, I know they may be, in great degree, ful-
filled^ by a hygienic system of management. Thus the wet-
sheet packing, and the compress, are adapted to allay irritation,
both in the stomach and lungs. The shallow and sitz baths, with
moderate water drinking, give tone to, and augment the digestive
power of the stomach, besides aiding a better distribution of blood
to the surface. In fact, the quantity of aliment that may be
digested, without distress, too, under this regime, is sometimes
enormous. All this is assisted by exercise. The lungs, mean-
time, being filled by an atmosphere which should be dry, and not
at any time below 45° of Fahrenheit, and never range further
than thence to 60° in winter, would receive but small irntation
from vicissitude of climate (and it is variation more than coldness
that harms), at the same time that the irritation, coming from the
stomach, would be diminished; so that their local excitement,
whether of a tubercular kind, as in incipient consumption, or of
an ulcerative kind, as in confirmed consumption, would at least
be modified, and its results prolonged. But in following such a
system, the greatest discrimination and tact is demanded, both as
regards the water processes and the other hygienic means. It
were impossible to. go at length into the minutiae of the subject;
and I would repeat that, although I know from the experience of
two cases, that incipient consumption has been retarded for more
than two years, it is altogether incurable by water, physic, or any
other known treatment. Neither the un inflamed tubercle can be
removed, nor the ulcerated cavity it has left, healed :

" Haeret lateri lethalis ■arundo,*'

not to be withdrawn by human art. Yet I am so convinced that
the judicious use of the water treatment reduces the harassing
^vils of consumption, the hectic, sweatings, bad sleep, and languor,
and prolongs existence to some extent, that I have judged it pro-
per to make these remarks, although they are not apropos to cure.
But is it not gain to be spared even a little of the stupor of opiates,
the exhaustion of bad sleep and sweatings, which are the '* heavy
day on day" of patients in consumption ? That these can be in
great measure avoided, notwithstanding the unceasing onward
progress of the miserable malady, is shown in the following ex-
traordinary case, with which I close the subject : —

190 PULMONART CONSUMPTION. j

Case Xn. — ^Pulmobart Cohsumftioh.

A young lady, aged twenty-five, three of whose sisters had died of
tubercular consumption, came to Malvern in December, 1842, and wtm
visited by Dr. Wilson and myself. We ascertained by the stethoscope
that there was ulcerated cavity in the left side of the lungs, as large as
a small orange. This, ike only certain sign of true amsumptiovil wan
accompanied with cough, enormous expectoration, frequently bloody,
perspirations, and so forth — signs that may exist loilhout an ulcerated
cavity. In the course of the first three months after she came here, it
happened that four or five medical gentlemen from different parts visited
Malvena, and were taken by Dr. Wilson and myself to examine this
patient They all expressed themselves perfectly satisfied that she was
in true consumption, and spoke of her life's duration as probable for from
two to six months. We had her wrapped in the wet sheet every morning ;
a cold ablution after it ;' a cold sitz bath for fifteen minutes twice a day ;
and a cold ablution at bed-time. She wore a compress on the chest
and pit of the stomach ; and she drank seven or eight tumblers of water
daily. Under the operation of this treatment she got rid of all fever ; her
rest at night was complete ; her cough became confined to about half an
hour on waking each morning ; when, however, she expectorated nearly
half a pint of pus ; the sweatings ceased ; and, from being oppressed and
distressed by food, she came into the most happy ignorance of having a
stomach at all, save by the appetite that took possession of it tliree times
a day.

A year passed over. In December, 1843, she was more ruddy, more
stout, and more cheerful, than in the previous winter. But the stetho-
scope gave signs of a cavity in the lungs much larger than in the preced-
ing year : the main, tlie destruptive disease was steadily gaining ground,
notwithstanding the wonders the water was effecting in other respects.
The most extraordinary part of the history is, tliat even at that time,
when the left side of the lungs was nearly excavated, she would rim up
the Malvern hills with very little shortening of breath ; and she could
read or talk for an hour together without cough or distress of respiration.
All tJus gave her that hope which attends upon others afflicted with this
deadly malady, who have far less apparent ground for it than she had.
Few in this life were better prepared for another than she was ; but this
absence of all bad signs, save one, came in aid of nature's yearnings,
and she clung, with a certain hope, to the prospect of recovery. But it
was vain.

At length, in April, 1844 — seventeen months after her appearance at
Malvern — she became all at once nervous, sleepless, without appetite.
Some gastric derangement had taken place, and with it her hope fell to
the ground, as it does in all stomach disorders. She spoke of her ap«
preaching end with the greatest composure, and expressed a wish that it
should take place among her relatives in Devonshire. Thither she went

.PALPITATION OF THE HEART. 151

Id May, 1844. I gave her directions to follow out some parts of tfaa
water treatment not so active as those she had already pursued. She cor-
responded with me on the subject of her disease ; she rallied repeatedly
both in stomach and hope; sank again; in January, 1846, her letters
bore the marks of delirium ; but she did not sink into death until March*
1846, tiDO years and four mofUhs t^ter she had been found to haioe a larg9
eonsumptive cavity in the lungs !*

§ 4. Palpitation of the Heabt. — Organic Disease of the
Heart.

Heberden's remark on palpitations of the heart, *' Aut mdbi
reqwrnni, aut omnia vznct^,"f is more epigrammatic than true,
when t!ie water treatment is concerned. Ordinary nervous pal-
pitation does admit of cure by that treatment, and it is of the first
importance to cure it. It is only a symptom of irritation in the
great nervous net-work about the stomach, generated by food, by
alcoholic drinks, by mercurial courses, by the presence of worms
in the digestive canal, by accumulations in the colon, by retention
of the menstrual fiux, by mental affections,-r-all acting on the
centre of nutrition, whence morbid sympathies are propagated to
the centre of circulation, producing irregular action there.
Whether such action owns this source, or is attributable to struc-
tural disease of the heart, can only be certainly determined by
the stethoscope ; the " bellows" sound being the characteristic
of nervous disorder there. But after all, the malady to be treated
is irritation of the ganglionic • nerves at the pit of the stomach.
Accordingly, the packing with a wet towel down the front of the

• This case is given by Dr. Wilson, at p. 18 of his pamphlet, entitled
*« The Practice of the Water Cure." He there says, «* My opinion is, that
reparation will take place, and Dr. Gully coincides with me. There is
nothing to prevent her going on with the treatment, until the desired
result is obtained.*' And again, " The patient was put under a regular
course of treatment, and soon got into perfect health, in which she remains
at this moment " As I am unwilling to see my name connected with these
statements, it is necessary to say, that I never coincided in the opinion that
reparation would take place,— all along I was convinced to the contrary*
and should be in any case of consumption. As regards Dr. W.'s statement
regarding the " perfect health" which this patient had attained, it must be
attributed to want of knowledge on the subject, in consequence of her being
under my sole care during the last eighteen months of her existence
Recording a termination so opposite to " perfect health" as 1 have done, it
became necessary thus to explain the discrepancy.

t ** They either require no remedies or they conquer all.'*

152 ORGANIC DISEASE OF THE HEART.

trunk, fomentations of the pit of the stomach with warm, not hot^
water, cold sitz and fcot baths, are the remedies most employed.
Of course, where so great an organ as the heart is concerned, it
behoves to watch the treatment ; in such a case, no remedy whaU
ever is safe without minute attention. Thus the wet-towel must
be applied as the mucous membrane and skin are more feverish,
and in no case continued for a long time together : there should
be an intermission of a few days every now and then; and mere
sponging with water not lower than 60° should bfc in place of the
cold shallow bath. The fomentations should be only a good de-
gree of warmth, not hot ; neither should any part of them touch
the ribs, for in either event they rather set the heart beating.
The same applies to the compress, which, however, should be
often changed ; otherwise it is apt to make the heart irritable.
The sitz baths at 60° should be taken for half an hour at a time ;
they always rediice the pulsations of the heart ; and the foot baths
cause a derivation that seldom fails materially to relieve the vis-
ceral irritation. In fact, the treatment should be sedative ; all
vehement reaction should be avoided, since it is necessarily
effected by quickening the circulation, which is as necessarily the
work of the heart. This is especially the reason wherefore it is
improper to drink large quantities of water, which are highly
stimulating to the general circulation. I have always directed &
large wine-glass full only to be drunk at a time, and hot more
than from one to two tumblers in the day. To follow the Graefen-
berg rule of drinking as much as possible in all cases, would be
to verify the accusation which some have brought against the
water treatment, that it causes heart disease. Active exercise ia
also bad. I think it very probable, that palpitation of the heart
has been induced by the indiscriminate water drinking and inces-
sant walking which are inculcated by those practitioners who,
themselves lacking thought, draw all their inspiration from the
routine of Grftefenberg. But, with care to avoid all revulsive
effects, palpitation of the heart is a perfectly curable malady by
the water plan, as 1 have ascertained by several cases, one of
which I give briefly.

Case Xm. — ^Nervous Palpitation of the Heart.

A youth of twenty-two years sought my advice in the summer of 1844,
for palpitations, from which he had I ^eh suflering for between two and
three years. They we-e exceedingly violent, and interfered with the

PALPITATION OF TiE HEART. 158

cirenlation sufficiently to prevent the return of blood from, And to con-
gest, the head, causing headache, and to congest the liver also. They
were present, with greater or less vehemence, when lying, sitting, oi
walking ; and they were aggravated by food. The pulse was generally
about 100. The pit of the stomach was sensitive on pressure, and
afforded sensations of sinking and gnawing. The appetite was good;
the bowels tolerably regular } but, as often happens in irregular action
of the heart, whether from organic or nervous disease, the kidneys acted
capriciously, now scantily and then excessively. His sleep was dreamy,
as is usual in cerebral congestion. Awake, he was in a constant state
of trepidation, blushed, and was ready to sink when spoken to. The
tongue was clean, swollen, and fiery red, bespeaking a high degree of
nervous dyspepsia. Extreme flatulence was the most palpable sign of
indigestion he exhibited.

The gradations of the tepid and cold sheet rubbing were passed through
by this patient. Then fomentations were applied over die stomach for
half an hour every night. He took one sltz bath at 65^, and one foot
bath daily. He was kept on very low diet, having a small quantity of
meat only every other day. I directed him to take a wine-glass of water
when he liked, and only then ; and I advised gentle horse exercise rather
than any walking. In the house I ordered him to keep the recumbent
position, with the head high. After a fortnight of this treatment, I had
him packed in a towel once and then twice daily; but after four or five
days of the twice packing, I found the daily double reaction becoming
too much, and therefore reduced it to one daily packing again. With
this he went on for three or four weeks, with intervals of a day now and
then. The warm fomentations, too, were continued ; but he was only
able to wear the compress a part of each day. No water that he used,
except that for the foot baths, was under 60° ; and as it was the summer
season, no shocks came from that source. By perseverance in the cau-
tious and accommodating course I had from the beginning pursued,
watching the capabilities of his body, and desisting from or augmenting
the treatment in accordance, this youth left Malvern, after seven weeks'
residence, as nearly well as possible. I recommended him to take a
round in Wales on his way to the North of England, and gave him direc-
tions how to proceed with a modified water treatment at home. Six
months afterwards he wrote to me thus : — •

*' It is so long since I left Malvern, that I feel half ashamed to commence
& letter. I deferred it at first, in order to be assured of the permanency
of the cure. I am glad to be able to say that, if thou hadst told me how
1 should have been three or four months after leaving Malvern, I should
no more have believed it than if one should now tell me that, four months
hence, I should be mayor of Sunderland, or rather that I should be strong
enough to fell an ox with my fist, or roll up ^ pewter plate. I am fear-
ful of boasting, but I consider it only due to thee to say whether thy
treatment be succeisful or not My joorney through Wales waa r^tf
8*

154 OKOANi; D]SEAS£ OF THE HEART.

beneficial as thou hadst predicted. I did not feel very strong for a we^
or two after coining home, but I soon found that I was improving, and
gaining in strength and weight. I discontinued the treatment after about
U^ree months, with some small exceptions, and am now in better health,
I may safely say, than I have been for some years. The palpitations
never trouble me now, except I get some indigestion from indiscretion ;
so that I quite hope that, with due care, they may be entirely overcome."

Let us suppose that this youth had not been relieved, but, on
the contrary, had gone on with indiscriminate eating, exercise,
and mental emotions ; what would have ensued ? The moroid
sympathies sent from the digestive organs to the heart, and
which, so long as they only affected the nutrition of the nerves of
the heart, would only cause varying palpitation, in the course of
time would have affected the nutrition of the muscular substance
of the heart, and thus organic disease of the heart would have
been established^ It is always so. First, there is the nervous,
or, as it is sometimes called, the functional, disease of a part, in
which the nutrition of its organic nerves is disordered, and this
affects the organic secretions, sensations, and movements. Up to
this point, the effect in the heart, for instance, is dependent on the
cause in the stomach, and intermits or increases with it. But
gradually the disorder of nutrition extends from the tissue of the
nerves to the tissue constituting the bulk of the organ, and then
bjgin the phenomena of structural organic disease, which con-
tinue in spite of their primary cause. A new and an incurable
disease has been established. Numberless are the instances of
structural heart disease which might have been avoided had this
view of iheir origin been steadily maintained and acted upon,
whilst yet mere curable nervous palpitations existed, and were
dependent on digestive influence. But the minute ganglionic
nerVous sympathies of the viscera are sadly overlooked ; and no
better instance of such neglect could be offered than the Latin
axiom with which I commenced this section, and which proceeded
from the pen of a writer whose position in the medical world was
of the highest. Nervous palpitations do require remedies, and
aught to be treated, Heberden's dictum notwithstanding. It is
only then that they are curable.

Although most averse to having anything to do with organic
heart disease, I have been as it were compelled, in three instances,
to attempt something for* it. In each case, the amount of relief
obtained astonished me. The remedy was a small wet sh^et

PALPITATIOIf OF THE HEAKT. 155

wrapped round the trunk of the hody, or a large towel down the
front of it, and closely covered with blankets. This was done
generally twice daily ; and sponging with tepid water of the parts
that had been packed followed. The general quietude and de-
creased action of the heart was always striking, but did not last
more than a few hours ; hence .he necessity for its frequent repe-
tition. And it was always practised once in the evening, in
order to secure some sleep, which it seldom failed to do. Its
action on the kidneys, which are generally torpid in this malady,
was most beneficial, altering both the quality and the quantity of
the urine for the better; indeed, in one case it succeeded so far
as to transform legs that were as hard as marble, with accumu-
lated fluid, into flaccid masses of flesh. I believe all this to be
done by the soothing and alterative influence of the wet sheet on
the ganglionic nerves supplying the heart and stomach ; for not
only was the action of the heart less irregular, but there were
signs of amended digestion in the tongue, feelings after eating,
diminished flatulence and acidity, &c., which, no doubt, allowed
of the better action of the kidneys, intimately connected as the
functions of those organs are with digestives. But the result on
the air tubes of the lungs, in one case, was the most satisfactory ;
the wet sheet and tepid ablution after it actually abolishing a
cough which arose from the inflammation of the bronchi, so
usually attendant on organic heart disease. This was in a case
of aneurism of the heart, accompanied by enormously enlarged
liver, dropsy in every cavity of the trunk, and of all the limbs ;
yet did the wet sheet both subdue the cough and augment the
urine.

In all these instances, the partial wet-sheet packing and tepid
sponging were the only parts of the water treatment employed ;
no others, not even hot fomentations, are applicable; in fact,
these last increase the irregularity of the heart*s action. It is
needless to add, that so soon as the wet sheet is given up, the
evils of the patient's lamentable condition immediately grow
again ; and why ? there is a standing, immoveable cause at
work.* Still I have thought it right to note down the fact, that

♦ At page 91 of Dr. Wilson's pamphlet, « The Practice of the Water
Cure," an account is given of the disease and death of a lady of rank,
about which some explanation is necessar-y. Hers was one of the cases
alluded to in my text ; and she died at Malvern under my care, persisting
to remain here and be treated, notwithstanding my assurance, at the very

16# OEOANIC DISBA8B OP THB HBAET.

alleviation of some of the distressing symptoms of this incuraUe
malady may he so far ohtained as to render life less intolerable,
and perhaps death more distant.

first visit, that nothing could be done. In speaking of her death, Dr. Wil-
ton has expressed himself so unluckily as to make it appear that the lady
was under JUt care ; which wa« so far from being the case, that he never
saw her but aneet when I took him, after overcoming the lady's objections
to it. It is but fair that he should be exonerated from whatever reproach
attaches to a medical man whose patient dies of an incurable disease. She
was my patient, died under my care, and hers is only the second death that
has occurred among those whom I have attem ed here.

VHaJOMB OF TBB NSSTOUS STTSTEM. ItT

CHAPTER ni.

DISEASES OF THE NERVOUS SYSTEM '

Regulator function of the Nenrous System on Nutrition and Secretion— »
Functional and substantial Disorder of the Nerves — Distinctions between
Nervousness and Hypochondriasis — Symptoms of the minor degree of
Neuropathy — ^Hypochondriasis and its Treatment — ^Essential character of
Neuralgia— Tic Douloureux of the Face— Sciatica — Nervous Headache-
Distinctions between Apoplectic Fulness and Congestion of the Brain ;
Reduction of both states— Paralysis and its treatment — Chronic irritation
of the whole ganglionic System — Spurious Palsy.

After being formed by the stomach and the lungs into material
fit to nourish the body, the blood is distributed to every portion of
it, entering the ultimate blood-vessels or capillaries, where the
third process of nutrition tokes place. But besides the nutrition
of the tissues which takes place in the capillaries, secretion, a
highly important function, is also there effected. The blood de-
posits the solids of the nerve, muscle, bone, &c., of the body, and
also the mucus, bile, tears, urine, fseces, skin, &c. It might ap-
pear, then, more in train to treat now of the diseases incidental to
this third part of the granct process of nutrition. But it must be
remembered, that it takes place under the influence of that por-
tion of the nervous system called the ganglionic ; and it thus
seems more desirable first to mention the diseases of that portion.
This has been done to some extent in speaking of the digestive
organs, where its great centre is. But, as I have said before (p.
4), wherever the matter of the body is deposited, there are gan-
glionic nerves presiding over it. Now the brain and spinal cord
represent the next great mass of ganglionic nervous matter to that
of the viscera ; and so close are the sympathies between these
two masses, the one in the viscera and the other in the brain, that
in treating of nervous diseases it is impossible to separate them.
Accordingly, this chapter is dedicated to the consideration of the
maladies which arise out of the sympathies between the viscera
and the brain and spinal cord. And let it always be borne in

m NIBVOXTSNBSS— NBtTBOPATHT—

mind, that inasmuch as the hrain matter itself is deposited under
the' ganglionic influence alluded to, all the phenomena of the brain,
are attributable to modifications of the same influence. It is only
by keeping this in mind, that the extraordinary power of the brain
and spinal cord over the natrition and secretion in other tissues can
be made clear. Mental affections cause emaciation of the body,
because the nutrition of the body and brain are under the same
influence. Terror causes enormous secretion of air or fteces in
the bowels, because the same ganglionic system of nerves pre-
dominates over the nutrition of the brain and the secretions of the
intestinal mucous membrane. It is, in short, impossible to have
irritation in the visceral ganglionic system, without having it
more or less exhibited in that portion of the system which regu-
lates the nutrition of the brain, spinal cord, and nerves thence
arising ; and equally so, to have cerebral irritation without the
visceral nerves being affected by it.* The practical bearing ot
this physiological conclusion is of the fii*st importance, as will be

• seen in the course of this chapter.

In arranging the maladies to be treated of, I shall pursue the
same plan as heretofore ; that is to say, I shall first refer to those
which exhibit yttwcfe'onaZ disorder, without any palpable substantial
change in the nervous organs ; and next, to those in which the
diseased phenomena depend on evident fulness of blood, com-
pression, or change of structure. In this way we shall speak in
succession of nervousness, hypochondriasis, neuralgia, or nerve-
pain ; apoplectic fulness of the hrain, congestion of the head, para-
lysis. Finally, this will be the best place to give some account
of two maladies which I have observed in my large opportunities
of beholding chronic disease at Malvern, and which I have not
seen described by any medical author : to one I have given the
name of ganglionitis, or chronic inflammation of all the ganglionic

■ nerves of the viscera ; and to the other spurious palsy, to which I
have alluded in the first part of this work. (See p. 7.)

§ 1. Nervoxtsness — Neuropathy — Hypochondriasis.

It is impossible to be afllicted with either of these disorders
without having the brain involved, but it is in very difierent do-

* In both cases, the diseased sensation of the body is built upon the dis-
eased irritoHon, as represented by the capillaries, as I have shown elie*
where. (See p. 4.)

BT700H0NDBU8IS. tM

grees. In both, the starting point is in the visceral nervous sys-
tem. In simple nervousness, the brain circulation is kept in an
irregular condition by the irritations proceeding from the viscera ;
the patient varies exceedingly in his sensations; his mind is
vividly alive to ah subjects, and full, of passing imaginations;
exquisite sensitiveness to all external things is his torment ; and
his secretions vary as much as his sensations. There is as yet
nothing fixedly wrong in the head. But this persisting for a long
time, and aggravated by treatment, may, and constantly does,
pass into the more intense degree of nervousness to which the
name of hypochondriasis is given. In it the patient is only alive
to one train of thoughts, which refer to the health and safety of
the individual ; external things only act upon him as his diseased
fancy pictures their action on his health ; his secretions are coti
stantly deranged; everything announces a continiwus derange
ment of the circulation in the brain.

In this work it is impossible that I should enter at length into
the multiform symptoms of either form of neuropathy ;• they,
whom it concerns will find the subject treated in full in another
of my writings.* A resume of those of the ordinary nervousness
may, however, be made in the following manner : — Indefinable
uneasiness ; despondency or irritability of mind ; diminution of
physical strength ; yielding and tremblings ^f the limbs ; start-
ing at noises and sights ; giddiness, and tendency to faint ; sense
of sinking or dragging at the pit of the stomach ; sensitiveness,
or pain in the abdomen ; pains, generally of a transitory nature,
in various parts of the body ; partial and occasional obfuscation
of sight ; numbness, or, on the other hand, preternatural sensi-
tiveness of some point ; partial sensations of heat, as in flushing
of the face or burning of the eyeballs ; creeping sensations ;
itching sensations, particularly of the eyelids, nose, or scalp ;
shuddering, with or without external causes ; involuntary twitch,
ings of the limbs and face ; palpitation of the heart, and at the
epigastrium ; sighing ; hard cough ; sense of dread or shame
without definable cause ; tendency to incessant motion and change
of place ; sleeplessness, or broken, dreamy, unrefreshing sleep ;
appetite capricious, sometimes, however, unchanged and steady ;
nausea, or vomiting ; secretion of the mucous membrane of the
eyelids and nose generally diminished ; eyelids red and turgid ;

* Ezpoeition of the Symptoms, &c., of Neuropathy, 1 vol., 870. 1840.

MO NBByomncBBS — nsttbopatht —

the tongue sometimes foul, frequently otherwise, hut for the most
part redder or more turgid than usual, with tendency to dryness ;
bowels costive, but frequently distended with air, and rumbling ;
urine varying with the nervous symptoms or the food ; counte-
nance ofttimes unchanged, but more frequently anxious, or, as it
were, on the qui vive ; complexion often florid ; emaciation
rarely to any extent ; feet and hands almost invariably cold and
clammy.

Such is the cohort of morbid signs under which individuals
may continue to drag on a feverish sort of life for weeks, months,
or years ; moving among their fellow-men with a constant dread
of collision, physical and mental. To them, excitements come
as shocks, which to others more happily circumstanced are the
pleasing stimulants that render delicious the cup of life. To
them, new acquaintances, novel scenes, varying modes of life,
the motley and complex associations that keep the normal nervous
system in active though healthy play, are, for the most part, elec-
tric impressions, which, after elevating the feelings **' Olympus
high," and engendering a painful excitement, " leave the flag-
ging spirit doubly weak." Yet are the nervous ever craving for
excitement : it seems as if they secreted an immense quantity of
nervous energy which must be wasted on some object or other,
else it would prey ^ipon themselves. They seek society, and
come out of it exhausted ; they seek continual food for their pe-
culiar sensations ; they yearn towards excitement, even as the
moth towards the consuming flame : they are leaves that tremble
with every wind of circumstance, yet to whom a calm is desola-
tion. The unceasing stream of sensations from the viscera is
ever acting on the mental organ, maintaining it in a state, almost
of orgasm, or at least of super-vitality, rendering it thereby con-
stantly prone to the exercise of its function, and that function ex-
cessive — a convulsion rather than a well-Ordered operation — an
involuntary, rather than a voluntary act. It is because the brain
is kept in a state of vivid perception, by the irritations proceeding
from the ganglionic viscera, that all the external senses are so
sensitive, and all the internal senses and the thought are so pain-
fully busy. Did not such irritations play on the brain, it would
be calm enough in its perception of outward, and its regulation
of inward sensations. Behold a man before and after dinner :
his brain feels and thinks diflerently, because his stomach does.
Nor are the phenomena of nervousness merely mental, nor the

HYPOCHONDRIASIS. 1§1

restilts of mental agitation alone. Restlessness, fidgetiness, im-
patience, tense countenance, tremulous movements, &c., ^., are
truly evidences of a brain in a state of vehement excitement.
But examine further into the peculiarities of one so afflicted, and
you shall find him possessed of an excitaole heart, that begets a
changeable pulse, and palpitates with the slightest mental shock :
of a tongue and mouth which become dry from the same cause ;
of a stomach whose function is disturbed by the smallest circum-
stance, the appetite of which, though good, is speedily satisfied or
annihilated, which sinks and yearns from trivial causes ; of in*
testines, that, on the operation of similar causes, secrete volumes
of air, are agitated, rumble, or, on the other hand, give the sensa-
tion of a vacuum in the abdomen. And these are only a few of
the ganglionic symptoms which aid in making up the nervous
condition.

But this is not all. A nervous brain not only owes its condi-
tion to the ganglionic irritation, but the amount and character of
the nervousness is regulated by the amount and character of that
irritation. If, for instance, the womb add its excitation to that
of the stomach, we have the characters of hysteria ; if the liver
be disordered as well, we have the utmost amount of imp itience
and suspicion imparted to the nervousness, &c. In short, the
brain only feels as the viscera dictate ; and none know this better
than nervous people themselves, who seldom speak of their cere-
bral, but invariably of their visceral sensations.

The brain, then, in the simple or minor degree of nervousness^
receiving exciting sympathies from the viscera, is itself excited,
and reacts upon those viscera, and a morbid interchange of sen-
sations is thus established. If the attempt to- remedy this by*
stimulants, dietetic, medicinal and mental, be persevered in, the
circulation in both points of excitement becomes more and more
deranged, the morbid sympathy between them becomes more and.
more firmly established, until the brain becomes at length inces-
santly bent in its thought upon the viscera, whence it derives so
much irritation ; — when this tsikes place, the second or major
degree of nervousness, commonly called hypochondriasis, may
be said to be established. Then commences that life of mise-
rable anxiety about the health, and, for the most part, the
health of some of the viscera, which the sufferer cries to
be rid of, and which the physician can so seldom allevi-
Ale. The brain is more fxedly implicated in the mischiefj its

W3 NBBYOUSNBSS — NSUROPATBT —

circulatioD and nutrition oontmumsly deranged, and its morbid
mental phenomena incessant under all circumstances : in fact, ita
function is now as much disordered as that of the viscera, and it
preys on them as much as they prey on it. Further^ the change
in the character of the nervousness seems to show an oppression
of the brain and of the spinal cord, the seat of the will ; for
whereas in simple nervousness there was much flightiness of
thought and vivacity of the will, in hypochondriasis the former is
bent with unswerving fidelity upon one subject, the health, and
the will is almost annihilated. Even the fact of incessantly
thinking on one subject exhibits the small degree of volition, of
command over the thoughts ; and this want of command descends
to the external senses, and to the limbs. Nothing is more com-
mon than to see hypochondriacs who cannot, because they will
not, see and hear, or who protest they cannot get out of bed, or
rise from a chair, simply because they will not. All the facts of
this miserable malady go to prove the obstructed function of the
brain and spinal cord, their oppression by the stream of morbid
irritations arising from the viscera.*

* The following are the conclusions to which I have come, after a full
examination of the facts regarding the healthy and morbid function of the
nervous system. The facts as well as the conclusions are to be found at p.
126 of my work on Nervousness.

,1. Morbid impressions commencing in the brain are reverberated, more
or less rapidly, on the visceral ganglionic system, exciting in the viscera
'sensations and movements

2. Morbid impressions commencing in the visceral nervous system are
reflected on the brain.

3. Anormal sensations and movements in the viscera, however generated,
are reflected on the brain.

4. The brain has no cognizance of a morbid impression except by the
sensations excited in the viscera.

5 The degree and species of the morbid visceral ganglionic sensation
regulates that of the cerebral sensation.

6. In neuropathy, the brain is the medium by which the unusual sensa-
tions in the viscera produce their effects on the economy at large.

7. The sensations of the visceral ganglionic system morbidly irritate the
brain, and, according to the degree of that irritation, produce either the
minor or more intense degree of neuropathy, the brain being more involved
in the latter than in the former.

8. The essential nature of nervousness is, therefore, to be found in the
morbid irritation of the visceral ganglionic system ; and as the anormal
sensations are more especially referred to its epigastric centre, this would
appear to be the most seriously implicated.

HT?0CH0ND]UA8I8. i«9

Nervousness, therefore, and hypochondriasis, are different de«
grees of the same morbid state ; the latter being the aggravated
form of the former. Yet the difference is sufficient to make a
distinction of great consequence in the treatment.

In nervousness, the soothing processes are the most desirabloi
for in it the symptoms are those of highly excited vitality ; per-
ception, sensation, thought, volition, as well as the organic func*
tions, are all rampant, restless, and irregular ; the nervous sys-
tern is strung to the tightest pitch, and vibrates painfully to the
slightest touch. So much is this the case, that even the most
nnoderate treatment frequently requires to be intermitted from time
to time, to aflbrd rest to the organization ; even it is too much to be
continuously applied to a body which is like one vast sore, so ex*
quisite are its sensations. If in commencing nervous cases the
amount of treatment be one jot too much, too stimulating, too
straining in exercise or the water applications, the nervous sys-
tem " o'erleaps the sell and falls on the other side," and things
are worse tKan before. Hence the impossibility of successfully
treating any two cases exactly alike ; and the absurdity of the
routine of large water-drinking, everlasting walking, indiscrimi-
nate diet, and pell-mell and hap-hazard packing and bathing,
which marks the practice of those whose easily-earned diploma
dates from Gr&efenberg, after a short residence there. It is not
so that the ever- varying disturbances which constitute the minor
degree of nervousness are to be quelled.

In hypochondriasis, on the other hand, all the functions— men-
tal, motor, and organic — ^are working slowly, as if under a load ; ,
a load which may be thrown off by the mind, if the organic powers
resident in the ganglionic nerves can be made to relieve them-
selves. To do this, they must be roused by the stimulating appli-
ances of the water cure, both external and internal ; by alternations
of treatment, in order to have changes of stimulus ; whilst, to
avoid interference with the organic efforts thus attempted to be
excited, the digestive organs are allowed to have as little as pos-
sible to do compatibly with the maintenance of the body. Nor will

9. This irritation of the visceral ganglionic system most probably con-
sists in an increased influx of blood into, and nutrition of, its tissue.

10. It is highly probable that congenital or constitutional nervousness
consists in an unusual development of the visceral ganglionic system, and
consequent unusual susceptibility to impressions from the brain, the equa-
ble function of which is disturbed by the vehement sensations that are at-
tendant on su6h susceptibility.

164 NEBVOUSNESS — NEUHOPATHY —

this be very small ; for in order to excite the same organic efibrt
in the brain and spinal cord which I have said is an aim as re-
gards the visceral ganglions, considerable exercise should be prac-
tised both on horseback and afoot, in proportion with which should
be the amount of food. This gymnastic of the limbs is only of
use as it is the gymnastic of the will, which it brings into play,
thereby convincing the patient that he can walk. The same must
be done for the mind. Every one about him should be instHicted
not to hold converse with him about his ailments, but to force hira
into some other subject of thought, and, if possible, such as shall
most absorb attention. In short, the whole treatment should aim
at exciting the organic and the animal nervous systems ; that is,
the ganglionic nerves both of the viscera and of the brain and
spinal cord.

Sometimes, however, patients come here with an amount of
feverishness of the mucous membranes and the pulse which re-
quires to be removed in the first instance. It haSj for the most
part, been induced by violent medication and dietetic imprudences
practised whilst refusing to take exercise to counterbalance them ;
and it is removed by the wet sheet. For, although an attack of "

fever is actually curative of hypochondriasis, and very many have
been cured by the supervention of small-pox, scarlet fever, and , .

other febrile eruptive complaints, yet no fever will avail for so
desirable an end which is not the product of a natural effort of the
body, and not of irritants introduced into it. In this instance,
then, the soothing wet-sheet packing forms an exception to the I

general practice in hypochondriasis.

All the cases which could be related would scarcely include
the infinite picture of simple nervousness. I here give one of the
most grievous that I have met with, premising that, happily, not '
many of those presented for treatment at Malvern are nearly so
bad.

Case XIV. — ^Minor Djegree of Nervousness.

A young gentleman had too early and freely been thrown into the
gay world of London. Constitutionally nervous, a vast amount of mor-
bid nervousness was soon added to it, in consequence of tke excitements,
both coarse and refined, into which he plunged. Late hours, women^
and ' their results, in the shape of a mercurial course, made up
the bead-roll of causes, and he became a neuropathic. Terror of some
unknown evil was always upon him ; he almost ran through the streets,

HVPOCUOKDRUSIS. 165

«s if fiom some pursuer ; he was always in a fidget and hurry ; his lace
bespoke the most intense anxiety, although full and sufficiently colored ;
there was a constant frown over the nose. Three or four times daily he
wa» seized with tremblings, fainting, cold sweat, and a sinking of the
bowels, as if they were falling down about his feet ; at such times he
was utterly paralyzed with fear. Luckily, the seizure gave him two or
three minutes' warning, in the growing sinking of the stomach, and he
would fly into a druggist's shop or a public-house, and swallow some
ether or brandy, though he had, otherwise, ceased the use of stimulants.
In consequence of these attacks, as well as the constant terror that beset
him, he never dared to be many yards distant from some one ; he was
therefore compelled to keep within the streets of London ; he dared as
soon have walked into Vesuvius as go, alone, upon a large commoB.
At night he was two or three hours before he could get to sleep, but
slept well, when once off, for about five hours. His mind was clear
enough on most subjects intellectually, but morally it was quite without
power ; touchy, impatient, yet without a particle of courage or firmness ;
as might weU be the case, seeing that the picture of impending evil was
always over him. His volition was inexhaustible ; he was driven, by
an impulse within him, to walk incessantly ; but this it was which, in
my belief, brought on, or at least made more frequent, the attacks above
mentioned. He ate and drank nervously, bolting his food as if he had
not eaten for a week; yet his appetite was not always good — ^never
krge. The tongue was large, split, and clean. He was troubled with
immense volumes of wind rumbling about the bowels ; which, however,
were in tolerably good order. The kidneys secreted a vast quantity of
limpid water, especially in the night time. The pit of the stomach was
the seat of great sensitiveness, sometimes on pressure, but always exhi-
bited in sinking, feeling of a ball, &c.; and there it was that, as he said,
everything he thought was felt ; and thence it was that all his disagree-
ables sprang. The skin sweated copiously with the smallest exercise,
and the hands were always wet and cold.

Against this array of miseries, I did not anticipate any speedy action
of the water treatment ; but I was wrong. Nightly fomentations with
hot water, and packing in the wet sheet, at first once, and soon twice
daily, immediately produced a soothing effect. The former made him
fall to sleep, even whilst they were going on. And both in the sheet on
waking in the morning, and in that at five o'clock p.m., he slept. He
changed the abdominal compress frequently in the day, and was always
quieted by the change. Five or six tumblers of water was his daily
dose. I forbad more than half an hour's exercise at once, and this he
took before each meal. Lean meat, bread, a small quantity of butter,
and salt, constituted his whole diet ; I even prohibited liquid at any of
his meals ; and he reclined for nearly an hour after them. The first
symptom which disappeared was the sweating of the skin, which be*
came more turgid. The sleep followed, but more slowlyi being evei;f

IM N£RVOU8IfXftS^*lfCtmOPATHT—

now and then deficient for ft night After be had been under treatment
abont three weeks, he took the cold uitz bath for half an hour at noont
and from that day his sleep improved. Occasionally his head ached or
Mt weak after the wet sheeting, which was then remitted for a day or
two, and a second sitz bath, or a foot bath in the evening, taken instead.
With these exceptions, the treatment continued as at first laid down, for
nearly six weeks, by which time this neuropathic had again and again
reached the top of Uie Worcestershire Beacon alone, and remained there
alone for half an hour or more, without a single tremor or mental quak-
ing. He had now licence to walk, and took advantage of it to such ex*
tent, that he once or twice came home quite knocked up in limb, but no
nervous sensations accompanied it. This showed me that the wet
sheeting should be diminished, and he 'therefore had it once daily instead
of twice. Having subdued irritation by its means, the object now was
to give tone. The douche was therefore employed at noon for half a
minute, and gradually longer; with the cold sitz bath in the evening.
With these he gained power with astonishing rapidity ; he took long
walks and rides alone ; he became cheerful, even to boisterousness,
which implies that the imaginary yet undefined evil had vanished from
his contemplation ; and though he was easily excited, it was quite within
the innate, and therefore unchangeable, nervousnsss of his constitution.
He left me at the end of ten weeks, a happier man than he had been for
the previous six years, between three and four of which had been spent
in dentroying his nerves, and the rest in nervous meditations on their
loss. He left me a happier man, not only because he had lost a train of
miserable sensations, but because he had gained the wholesome know-
ledge, that tawdry excitement is not true excitement, and that as much
real fun is compatible with early hours and sober habits as with their
contraries, and does not leave one quite so nervous. Perseverance in
his old course, and in the remedies he took for the attacks, must ere
long have either made this patient an incurable epileptic, or the inmate
of a lunatic hospital. He quitted Malvern fifteen months ago, and has
had no sign of relapse.

Case XV. — Minor Degree of Nervousness.

I will briefly relate tbis case, because the subject of it is a female.
She is twenty-seven years old, of a nervous constitution, strong in her
feelings and afifections. Two years before she came to me, a very se-
vere and sudden mental shock fell upon her. Hysterical, and subse-
quently more serious nervousness invaded her with intensity. This last
was experienced in fainting, death-like feelings, tremblings, universal pul-
iation and agitation ; but above all, by the most frightful and almost un-
controllable sensation of impulse within her, as if, so she said something
would raise her out of her bed or seat, and drive her out of the door of
window, or throogb the wall even: there was also in this dreadful feeUng

HYPOCHONDRIASIS. 167

I sense of impending insanity. These faintings and sinkings, the smalt,
exceedingly rapid pulse, ice-cold feet and hands, incapability of walking
above a very short distance, and want of sleep, set the medical gentle-
men whom she consulted on the path of stimulation — of supporting her.
She took every possible antispasmodic and opiate ; of brandy and wine
she was counselled to imbibe an abundance ; and the diet she followed
was in keeping — turtle and other strong soups, animal food twice a day,
coffee, cocoa, &c., being its constituents. Under this rigime^ to use her
own expression, " she knew no peace ;" day and night were passed in
waking and sleeping tumult, the sleep being as busy as the vigils ; the
total unrest, the incessant fears, palpitations, pulsations, &.c., all aug-
mented, the more she took remedies against them ; and when, after and
in spite of warning and remonstrances, she came to try my treatment, I
found as wretched a neuropathic as could be well imagined. Religion
had reconciled her to the blow which the Author of religion had inflicted ;
but its consequences remained in her physique, aggravated by the irra-
tional means which had been employed against it. Every organ and
function were in a state of maddened excitement ; looks, words, move-
ments, were all those of impulse and disquietude ; and she stopped seve-
ral times to shudder, whilst she recounted her mental nervousness. Her
organic functions were disordered too ; appetite almost gone ; all kinds
(A sensations within her ; pulse excessively i^pid and small ; slight ner-
vous cough ; bowels tolerably regular ; kidneys capricious in their action ;
skin liable to cold mois'^ure ; on the chin, and indeed any part of the face,
a tendency to small pii pies, which are so frequent in the nervous, and
often make their appea ance in an hour after a more than usual degi*ee
of nervousness.

Upon this lady, the soothing eflfect of hot fomentations at night, and
wet-sheet packing in the morning, was immediate. Nothing could bo
more satisfactory tlian to hear from her, each time that I saw her, thai
her sleep was improving, and the frightful impulses within her daily di- .
minishing. Within the first week she felt infinitely more calm than she
had been for two years. For some time her treatment was confined to
fomentation and wet sheet once daily, the latter being followed by rub-
bing with the dripping sheet. She took four tumblers of water daily.
Her exercise was limited to twenty minutes twice a day. Of course, all
stimulants were withdrawn from her diet ; she took tepid milk and water
with cold toast morning and evening, and a small quantity of meat with
two potatoes for . dinner ; this was her food throughout. By degrees I
had her packed twice a day, the sitz bath for a quarter of an hour at
noon, and the fomentations omitted. All along she wore the abdominal
compress night and day. Foot baths were given* once or twice a day,
according to the prevailing sensations ; for it is not to be supposed that
t)ie nervous feelings disappeared in a few days never to return ; now and
then a ** bad day " came, dependent as such days very often are in the
neuropathic, upon electric atmospheric changes, alteration of the wiiud

l68 NERVOUSNESS — ^MEUaOPATHY —

Slc, Nay, even the prolongation of the treatment, without cesBation,

will sometimes excite the nerves; and in this case I was compelled,
twice or thrice, to give all up except the dripping sheet and a short aitz
daily. But still her " bad days " were Elysium compared with her every^
day torments before coming to me, and she bore both with a beautiful
spirit. Twice for a few successive days she experienced nausea, as if
some internal crisis were about to appear ; but it once went off without
any result whatever ; on the other occasion a slight diarrhcea followed
it. With trifling variations for these circumstances, and an occasion-
al headache, the treatment of packing in the wet sheet was persisted
in during the whole time of her stay at Malvern, which extended to
fourteen weeks, when she was compelled to leave for home, but v(ith no
nervousness save that which is constitutional and congenital with her.

These two cases will suffice to instance the phenomena of great
nervousness, as it occurs in the two sexes, and of its general treat-
ment by water. But there is no end to the mingling of symptoms
in this distressing condition : and all that aan be done, is to refer
to the resume of symptoms above given, and to the applications
of the different processes of the water cure, to be given hereafter.
There is one kind of n%fvousness — that connected with what is
called, in females,, "ohange of life," about the forty-fiflh year, —
in which the treatment is only palliative ; the nervous tumult
persisting more or less, in spite of every mear i, until the " change "
is effected. Still, this is a period of severe trial, and not unfre-
quently of danger to important organs, the usual monthly irrita-
tion of the womb being liable to be thrown upon the heart, or
lungs, or head : and the sufferer will find in the appliances of the
water cure, a sure and certain way of preventing such danger-
ous transfers. I have had occasion to treat several females in
whom the extreme sensitiveness of the nervous system rendered
the period in question somewhat perilous on the score of this
transfer, and have succeeded in obviating it altogether, and making
the change of life less* distressing. This may always be done by
the moderate use of wet sheet or towel packing, short sitz baths
at 55° or 60°, warm fomentations to the abdomen, foot baths, and
rest of limb. Here, too, the circumstances of women vary so
much, some having excess, others deficiency of the uterine dis-
charge, some pain,^thers none, dtc, that anything like detail of
treatment is impossible. After stating the uses of the prooesseai
the practitioner must employ his discrimination in the particular
eases^ and the fluctuating circumstances of each. It is the only

HTPOCHONDHIASIS. 169

treatment that I have ever found of the slightest use at the perkxl
in question.

I now proceed to give a case of the greater degree of nervous-
ness. Very many patients alllicted with this terrible disease
have been under my care at Malvern : but with the proverbial
fickleness and restlessness attendant on their state, none of them^
save one, have remained long enough to enable the treatment to
act strongly and permanently on them. The consequence is, that
I am about to relate the only case of hypochondriasis which I have
had the luck and opportunity of curing : and it must be confessed
that i^is not one of the most intense kind. But few medicbl men
can record even one instance of cure of this most intractable and
intolerable disease : the physician being generally as glad to be
rid of the patient, as tbe latter is prone to seek pother adviser,
before any impression can be made on the symptoms.

Case XVI. — ^Hypochondriasis. The Greater Degree of Ner-
vousness.

This patient was forty-seven years old when he came to me in Janu**
ary, 1843. For twenty years he had been occupi^ as a commercia!
traveller, to the temptations of which avoca#on, in the way of dietetic
excesses, he had not been a slave; certainly not, at least, in drinh*
ing, his quantum being three or four glasses of wine daily. Neverthe-
less, being a very orderly and a very anxious m^, business was no play
for him, but a serious wearing and tearing afi&ir, in the fulfilment of
which he neglected all regularity of times of eating, sleeping^ &c.
Meantime, the travelling, the constant change, and the exercise he got,
combined to keep up a g^eat appetite, a morbidly great one in fact ; and
it outran the digestive power, which gradually diminished. He had
arrived, in short, at the phase of nervous dyspepsia. This was about
three years before he saw me. Distress after meals increasing, he had
recourse to phymc— tonic, aperient, cardiac, &c. Temporary reUef ob"
tained thence did not prevent, but rather quickened, the downward pnv
giess of his health. He grew anxious about his health ; consulted one
or two physicians in every considerable town be came to, took all their
prescriptions and went from bad to worse. Strange to say, not one of
them ever gave him rules of diet, or diminished his wine ! This was his
history for three years. He tried absence from business — ^no use ; it
rather made him worse. The fiend of hypochondria had fairly entered
him, and began to feed on his body, for he grew ^maciated as well aa
miserable. At length a celebrated surgeon of tondon recommended
lum to oome to me and try the water cure ; and, with much. quaking, Im

•I foud iam with all the worat vytofiUmm of nervous and mMomAsffit

17# IfBtYOVSMiCSS — VEOMOfMXBt —

fipriii exoq^ tfait tbt «jppetita was nntowdiad ; a awoQen, bj^ fcaj^
toagae, fcetid breath, obstiiiate bowels, dLc., Slc. Without mach sensa-
tioii in the abdomen, he always said his malady was there ; so truly does
the brain appreciate the source of its malaise, although no pain is present
to mark it His skin was in miserable plight, colorless and dead to the
tye, bat to his senses exquisitely aHve to the smallest change of temper-
ature; creeping, crawling, and cold trickling were always going on in
it. He had the nsnal variety of nerrons alaxms about his health ;
teit, as regarded his mind, the prominent symptoms were a loss of
volition that was tmly distressing, and hysterical depression. His
want of wiU was exhibited in an almost incapability of getting out of bed,
declaring that he could not, and in the want of decision in the most tri-
cing afiairs, the choice of a chair to sit on, &c. He would corned see
me, weeping like a child, deploring the slow and certun death he was
dying, beseeching me to save him, yet vehemently contradicting me when
I assured him it was possible. Between these two weaknesses he fell
into a fear of the treatment, and wesAoff suddenly, after about three
weeks' residence at Malvern, during which time he had been rubbed with
the dripping sheet, taken foot baths, been packed in the wet sheet a few
times, and drank seven or eight tumblers daily. He went away, was
absent for a month, ran the gauntlet of two or three physicians in Lon-
don, took their phys^p, went again to the surgeon before alluded to, wha
again urged him to come to me. This time I refused to undertake him
at aH, unless he pledged his word to remain with me four months at least.
In eoDBequence of a ccmsiderable amoant of internal nmeosa fever*
ItfaoeM, it was aeoasSary to employ wetHBheet packiafp for a laog time'iB
tins ease, and twice a-day after a little time. 'Rie cold shaUow bath was
used after it The cold sitz was taken once and then twice a-day. He
WGse the compress on tiie bowels night and day, drank ten and twdve
tumblers a day, and was instructed to walk as much as possible. As the
fever of stomach diminished, the wet-sheet packing was diminished also,
and the douche was commenced. It had a decidedly good eflect m
laising the spirits, taking off the misery of the skin, and giving a
general feeling of Men*^fv. * The quantity of water was increased to
fifteen or sixteen tumblers. He was next sweated in the UaidDete twice
and then thrice a week; the wet-sheet packing being only used.eesft*
rionally, to repress any feverishness that arose. This active practice of
sweating, wet^heet packing, douche, sitz once anlay for half an hour,
and the large doses of water, began to induce critical eflfecte after he had
been with me eleven weeks. The bowels became very much relaxed^
and vomiting of bilious and acrid matters attended. This rejoiced him
exceedingly, and for tiie first time he allowed the probability of recoir4
ery ; and in fe.ct his mental symptoms recovered from that date, histaffiy
■ensalions of the skin, dtc, and Ms sleep, having impfoved some wriwfcii
pievioasly. The treatment was persevered in notwithstanding, withwow
iftdayortWDoCiehuDfttiQii^ His>diet throughout had 1

HTPOCHONDBIASIS. tt|

pfey but I have since thought somewhat too {nil ; but it is dF no nasi
ing to hungry hypochondriacs, who have a great appetite and no voHtioii*
The appetite is sure to have its own way unless the doctor is always
present Throughout also his exercise was great, and rose at length
to ten, twelve, and fifteen miles daily. At first, under the operation of
the wet sheet, he lost fiesh, as is usual ; but he subsequently regained it
and more, and of a better quality besides. Much moral treatment was, of
^lirse, requisite, and fortunately I obtained considerable influence over
him, so that I was enabled to urge him to the exercise of his volition bOtlP
over the physique and over his fears. At the end of the four moBtlur
appointed I allowed him to go, deeming him sufficiently secure of health;
indeed he complained of nothing. However, he continued the dripping
sheet, sitz bath, and occasional packing for two . or three months more,
when several boils appeared about the abdomen and thighs ; he wrote to
me about them, and treated them by my written directions. I heard,
nothing of him for six or seven months afterwards, when he came to
Malvern to show himself, declaring that he " did not know what nehjes
meant" He is still flourishing, and likely to do so, since he has learned
the necessity of sacrificing some of the anxieties of business to the ezi*
gencies of health, such as regular hours of eating, &c.

§ 2. Neuralgia — ^Nekve Pain — ^Tic Douloureux — Sclatica—
Nervous Headache.

In nerwnunesf the viseeral irritation preys on the brain and
spinal cord in siich a manner as to pervert the mental operatiotttf
ovirried on through their instrumentality. The mischief in them*
is of a chai*acter which Weakens the power of the nerves sent oiit
from then^to the muscles, and diminishes the voluntary action of
these latter : but ho animal pain necessarily attends.

In neura^ia, on the other hand, there is the visceral irritationi
although of a diflferent phase^ whicn radiates to the spinal cord
i^d brain, but more especially to the former, and begets in then^
an irritative action^ whidi is exhibited in pain. The pain w
periodical, or rather intermittent, for it does not always observe
fixed periods. The intimate condition of a nerve in a state ofi
pain is known to be that of inflammation, that is, the blood.Tesselfl^
of the substance of the nerve and of its sheath are relaxed, gorged^
and, pressing upon the sentient matter of which the nerve is com-
posed, excite its sensitiveness to the amount of pain. It is true
that in many instances no trace of change cpuld be detected in the •
appiearance of nerves that were the seat of neuralgia for yeam
b^re death : but this does not militate against the existenoei of.
Alordered c^ncttlatbn in them, sixice it was always ittter a a lMM i iy

ITJ NSUIULOIA — K£BV£ PAIN —

and not likely, therefore, to leave trace behind it : it is only i
mat fuDotional disease that produces organic change.

But another irritation, namely, in the viscera, is connected with
this external one. Here, however, it is continued, lurking, liable
to be exasperated by a hundred causes, to such a pitch, as to rouse
immediately the slumbering nerve, on which it is wont to expend
its morbid sympathy. This exasperation of irritation in the vis-
cera, and for the most part in the ganglionic net- work about the
stomach and liver, coincides, therefore, with an Attack of neural,
gia : it is an invariable concomitant and cause ; and you might
as well expect to find a brain without viscera, as a chronic nerve
pain without visceral irritation. In fact, neuralgia is a rude
effort of the disordered viscera, to throw their destructive irritation
upon some external and less vital part ; it is a process of salvation
to the centre of life, and we accordingly find neuralgic. patients
the most long lived. Besides, it is notorious, that although tic
douloureux destroys the comfort of life, it never destroys life itself-
Were the internal disorder to be concentrated, then it would sap
the organs that are most essential to existence : a neuralgic out-
break prevents this.

As may be readily conceived, the frequent repetition of the
same irritation in a nerve, renders it more and more easily the
prey of the internal mischief: until the smallest possible increase
of the latter suffices to induce an attack : and the minutest causes
operate violently. The stomach being in a state of nervous dys^
pepsia is astonishingly alive to dietetic irritatives, which are a fer-
tile cause. Whatever agents disturb the nutrition of the body,
be it for ever so short a period, are apt to bring on an attack : hence
the operation of mental caAes, gusts of anger, surprise, &c. ;
hence too the exquisite sense of barometric and thermometric
changes in the air, and of its electric vicissitudes, which Uc patients
possess: these causes disturbing the general nutrition of the
frame, tell more especially upon the visceral centre of it, lighting
up its chronic irritation. I have known a neuralgic sufferer, who
felt and predicted a snow storm many hours before it took place,
and at a time when the sky was clear and serene : but on looking
to the barometer, I found U had experienced the electric change
. as accurately as, but not more so than, the patient. In fact, the
nutrition of the skin is always more or less deteriorated, and lacks
the power to react upon atmospheric conditions : dependent on tha
intenial state of the body, it is less able, in consequence of that

TIC DOULCrRETTX, BTC. Vtt

rtate being defective, to resist external impressions: and the
patient is oflen puzzled to account for an attack, when an accu-
rate barometer or electrometer would inform him of the exciting
cause.

What is the neuralgic constitution ? I have almost invariably
observed the disease among men in those of great muscular power,
and who have been in the habit of exerting it freely, and at the
same time taxing their viscera with high living and venereal ex-
haustion—circumstances most likely to create irritation in the
viscera, and to render the spinal cord and its nerves the parts in
which to excite a morbid sympathy. But the malady is also
observable in persons who have worked their brains to the detri-
ment of their stomachs, which they at the same time worried with
stimulants. On these two grounds we find more of the disease
among military men, and hard-worked men of law, than any
others. Among women it occurs in those whose deeply feeling
minds have trenched upon the integrity of their viscera ; or in
those who have strained the latter by rapid child-bearing, and
prolonged nursing of their children. The age most liable to' it is
between thirty-five and fifly years : but it begins at other dates.
Once established, it is generally worse in the spring than at other
seasons : stormy weather at any period of the year exasperates it.

Certain nerves of the body are more liable to neuralgic disease
than others ; and these have been written and spoken of as dis-
tinct maladies. To the neuralgia of the nerve whose branches
come out of the bone above the eye- ball, under the eye, and in
the lower jaw, sending branches to the whole side of the face,
and to the teeth, the specific term^f Uc douloureux is usually
applied. When the large nerve which runs behind the hip- joint
down the back of the thigh is affected, the disease is called sd'
adca. But Uc also occurs and, indeed, is pretty frequent in the
nerves of the arm, especially of the fore-arm. As a transitory
sign of dyspepsia, it oflen is felt in the fingers, in the shoulders,
and in the ribs ; for the shoulder pain I have seen calomel given,
under the idea that the liver was at fault: and I have seen
leeches applied for supposed pleurisy which some sal-volatile im-
mediately removed : so little are these sympathies recognized !
Worst of all, Uc is occasionally universal, every principal nerve
in the body being attacked in the course of twenty-four hours.
I have seen two cases of tic of the entire skin of the body, except
dhe face : in one case, to such an intense decree, that exposure

If I MEtnULOU — ^RBEVB PAIN—-

^tiim hand out of a glove for five minutes claused exquisite pais*
Xbe . skin, and indeed the whole subatance of one or both legSj
a^ , p^asionally the seats of severe nerve-pain. The scalp, be*
ing largely provided with animal nerves, which, moreover, run
in a, hard, inelastic tissue, is the seat of most severe neuralgia,
which, under the name of nervoui headache, is the daily torment
of thousands. All these forms are connected with the same inti-
nsate eondition of the, pained nerves, and with some phase of
viffceval irritation, always of a nervous kind, but sometimes with
the addition of raucous derangement. It is vain, in our present
kpowledge of the nervous system, to speculate as to the cause
why one nerve, rather than another, becomes the seat of nx>rhid
i^inpathy and pain. We have some grounds for saying that
liver • derangement is connected with sciatica : that nervous
disorder of the stomach itself is mostly found with tic of the face:
and that, when irritation of the womb is superadded to that of the
stomach, tic of the scalp, or nervous headache^ is the most cook
mon result. Yet all these are liable to exceptions : the great
point <»f practice is to know that visceral disorder of some scnrt is
at the bottom of them all.

The treatment of neuralgia is, in great measure, dependent
on the duration of the disease ; for the longer it has existed, the
greater the probability that the visceral derangement has reached
the point of obstructed function, and vice versa. In recent, and
not very intense cases, the excited state of the viscera points to
Ae expediency of employing those remedies of the water cure
that diminish irritation, such as the wet-sheet packing, fomenta-
tions^ short hip baths, small quantities of water, gentle exercise,
mild diet. * In 'the older cases, where mucous disorder and oh»
sfyructed function of the viscera obtain, it may be necessary to use
the wet-sheet packing from time to time, but the stimulating agen-
des oi the cure should especially be brought into play, such as the
s^eatiag, prolonged sitz baths, the douche, large doses of water,
and, if the legs be not the affected parts, a good amount of exer-
oise: if they are, a good amount of friction. But these are gsn-
eralitaes, and in this nK)re than in any other chronic disease, we
ind-^ commingling of symptoms, and conflicting considerations of
age, the exciting causes, the constitutional tendency, previous
treatment, and habits, <&c., of the patient, which must sway the
ovaetitioner when the detiedls of treatment are to be determined;
TWi*, sweating may be indioatea, and to a oertain extent sboiM

TIC DOUIiOUESUX) ETC. tW

l» practbed ; but the age of fiily-five years, added to mental
distr^tey as an exciting cause, may render die patient's head full ;
in which case, the effect of the sweating on the pulse and head
ahould be watched, stopped tnimedtately on fulness of die former
and tightness of the latter, and the wet-sheet packing or fixnen*
tations had recourse to, in order to reduce the circulation gene-
rally, and that of the head, in particular.' Haymg done which, we
return to the main indication. Of course these necessary wan-
derings from that indicati(m prolong the pnxsess of cure : but it
ifi for want of such precautions as I have just alluded to» that the
water or any other treatment becomes a dangerous one, as it it
sure to do in non*professional hands. In the course of the treat-
ment, certain disagreeables are also apt to arise, which it is well
the patient should understand beforehand, so that he may avoid
discouragement.

The first is actual increase of pain. This happens in the earlier
part of the treatment, and is accounted for by taking, as a basis,
the fact herebefore mentioned, that neuralgia is itself a rude efhri
of the viscera to save themselves by throwing their irritation oa
the external nerves. Now the effect of the water treatment is
«iaotly the same : it places the viscera in the best possible posi-
tion of vitality, to effect this diversion in their own favor. No
wonder then that at first the effort thus encouraged should be
towards the nerves, already the recipients of the internal morbid
sympathy, and that the old pain should be increased. But, as will
now be plain, this is rather a sign of the wholesome action of tiie
treatment, and should be a ground for hope rather than despoiw
denoy. For, as gradually the whole skin is brought into a mora
acdve state of function, the visceral irritation is thrown' upon U in
its extent, or upon the lower part of the digestive canal, in tho
shape of diarrhoea.

Tlie second disagreeable is the nadsea and general malaise
which attend the brisk action of the water treatment in this
malady. Yet, without these there is little chance of cure; for
they are the signals of that uprising of the dlgesdve organs which
pfv>cedes a critical action in acme other organs. The vis^end
irritation that attends neura^ia is one of the most deeply seated
and inveterate in character, arid the uprooting of it is therefore a
perturbating process for the time being : the disjointing of a l(Mig*
landing bad arrangement is not effected. without some inoonveni*
ence; but the end justifies and compensates for that. For As

J

176 XSUBALOIA — NSRVS PADT —

Teat, short sitz baths, or long foot baths, relieve very much of th«
nausea and malaise from time to time. As might be expected,
these signs are more prominent iu old than in recent vieuralgia^
But I hold that no itc of a Axed kind can be got rid of without
9ome critical action, and that generally a bilious outpouring by
the mouth and by the bowels, or sweating, or an itchy eruption of
the skin : but never boils.*

Case XVII. — Sciatica.

This patient is brother of the most distin^ished of the metropoiksB
surgeoas, who, indeed, reoominended him to come to me for a trial of the
water treatment He is fifty years of age, a person of most active mind,
occv^ying himself during a long day with matters of grave and complex
character, and even filling up hoars that are not recognized as those of
business with botany, gardening, d&c. ; in short, giving his mind no rest.
Withal, his position brought him, as host or guest, into not infrequent
dinner-parties, where, though moderate, he could scarcely be as abstinent
as, considering the mental labor and slight bodily exercise he took, be
ought to have been. The consequence was, that the digestives began to
give way ; he fell into ill health ; and, after two years of dyspqitic disor*
der, the internal irritation attempted to relieve itself by the production of
tic douloureux in the sciatic nerve. He bore this for one year, trying,
meanwhile, a variety of remedies, but to no purpose. The pain drew the
affected leg up, so that in walking he could not put the flat of the foot on
the ground ; and it also obliged him to stoop.

He had a variety of dyspeptic signs, although want of appetite was not
one. But a swollen tongue, somewhat split, inflamed back of the throat,
red eyelids, ydlow white of the eyes, and general want of activity in the
skin, bespoke something wrong at the centre of nutrition : and in that
oonvietion I treated his digestive organs and skin, leaving &e seiatiea to
fbUow in their train. For nearly five weeks he was packed onice and
then twice daily in the wet sheet, the cold shallow bath, and sometimes^
the cold dripping sheet after it : he took the cold sitz bath once, and some-
times twice daily : occasionally, he had a dripping sheet instead of a sits
bath : he drank ten to twelve tumblers of water : took horse exercise :

* In his paper on the water cure, in «* Colburn'a Monthly Magazine^ for
September, 1845, Sir Edward Lytton says, ** that neuralgia is one of th^
diseases not curable by the water treatment.?' Of course, his own expsffi*

ence is very small ground on which to frame this statement, which is
altogether incorrect. Had he been my patient, he would have had oppor-
tunity of hearing the contrary from one at least of the patients who are the
subjects of the following cases. But this is one of several inaccurracies in
the paper in question, inevitable by a non-professional person writing on 4
medical subject

no DODLotnusul, etc 17f

tod in diet avdded all hot liquids whatever, taking cftAj cold milk and
water, bread, butter, mutton, beef, poultry, potatoes, and rice. After a
month of this sort of treatment, and when the tongue had diminished, and
the inflammation of the throat much subsided, I began to sweat him and
doache liim daily : lie took tlie sitz bath also : the dose of water was
inereftsed : and the system was vigorously pushed. Under it he began to
have swimmings in the head, occasional nausea, and '' knocked up" feel-
ing, and his bowels acted for some time irregularly, sometimes torpid, but
more frequently relaxed. Such is the outline of the treatment which he
pursued to the end of the second month, when all manner of engagements
obliged him to leave Malvern, although against my advice. It is proper
to state also, tiuit m the course of treatment here, he ran up to London
for a few days : so that his residence near me was a trifle under two
months. At leaving, I gave him directions to pursue a modified treat- ^
ment at home. The pain was as nearly gone as possible before he left
Malvwn. This was in the autumn of 1844, and I heard nothing whatever
of him until June, 1845, when the following letter from him gave me his
hifltory in the interval, and conflnned the complete success of th^
treatment

" London, June I5th, 1845

♦* Mt dsak Sir, — ^I always intended reporting to you, sooner or later,
tlie resnk of ray consulting you, of my residence under your care at
Malvern for two months, and of my subsequent adoption, to a limited
extent, of the treatment you recommended. I might have reported my
complete restoration to health and strength, some weeks ago, but constant
and pressing engagements left me no time to do anything which I could
postpone ; and furthermore, I thought it would be more satisfactory to
see how far I could stand the trial of parliamentary work in London, and
not halloo before I was fiiiriy out of cover. I was certainly sent to yon
after two years' illness, and one year's sciatica, as one of the incmubles.
My general health improved greatly during ray residence at Malvern. I
•o &r lost the sciatica, that though I only walked with difficulty and oon^
siderable pain when I went there, £ walked perfectly free from pain when
I left. You told me I ought to have remained another month at least, and
I believe my cure would have been much more rapid had I done so. On
my return home, I adhered pretty closely to your orders as to regimen
till Christmas, about ten weeks after I left you, drinking about six
tumblers of water per diem, taking a bath in some shape nearly every
day, and occasionally a wet sheet under blankets. Though I was never
ddPtorwards inconvenienced by sciatica, I was occasionally reminded that
it had ]K>t been fairly exorcised; but these sensations very gradually
subsided. I then occasionally felt lumbago when I got up in the morn-
ing, to ,a degree which, in former times, was generally followed by a
severe shock on a sudden, which laid me on my back for a fortnight ; but
iince I was under your treatment, this has invariably gone off after break
9*

fut in « few minutes' waliung— ft perfectly new feftlmw in voji
&ive gradually resnoied my former occupatioDS without
with somewhat more indolgence than heietofiore, in point of boun, andl
have gradually dropped into my old habits of living, which were always
moderate ; that is to say, drinking wine only in oonpanf , eontiraiing ra^
five OS six tumblers of water in the course ii the twen^^^MV hoaiB, aai
daily shower bath, or dripping sheet when ftom homdi with a dry sheet
afterwards. I think I am now, in all lespceCs, as well as I ever wss^
making due allowance tot a diflerence of poweiv between twsnky and
fifty years of age.

" I am told that a residence at Malvern, free from the cares and sbb*
ieties.of business, would account for this beneficial cheage, ifi eepse tif s
of the peculiar treatment I uaderweol there. Tint may be ; but putial
trials of change of air and scene previously had not predueed any mariBsd
efl^t, and I attribute my restoration from very serious deisngement of
the nervous system entirely to the very rational and intelligible msds of
treatment adopted by you. You eTplained the cause of my disosder ; you
gave me the rationale of your treatment; you stated the eflects that yMi
anticipated from that treatment, and those eflects resulted. I think it

therefore sound logic to refer the result to the treatment Bin. *fl^

esse was most successfully treated, and the efbct c^mtinues. I tfaiidi it
tl^refore but due to attribute our improvement of canditioa to your skffi ;
and I have not hesitated, and shall not hesitate, to bear this testiaaosy in
all quarters. Wishing you every success,

^ I remain, my dear Sir,

« Most truly yours, ■ /*

Case XVIII. — ^Neuralgia, of both Legs.

In the Bsmmor of 1843, a gendeman of thirty-two years of age, who
had formerly been in the army, and had then led a very dissipated life,
l^aced. himself under my care at Mslvern. He had drank largely of
spirits, had passed through the stages of nervous dyspepsia, and was now
anifed at a oomplicatian of irritated and obstructed function of the diges-
tive organs that was quite lamentable. He had also been twice salivated
with mercury. His skin pale as death; his soft, flabby limbs — small,
rapid, and compressible pulse— all bespoke the extent of the internal
mischi^ which originated this painful afiection of the limbs. These last
were racked with pain night after night, notwithstanding enornKms doses
of opiates, and it was only towards morning that, between them and ex-
haustion, he dozed for an hour or two. The pain frequently returned hi
the day ; but, oddly enough, he could then suspend it, by tightening a
cord round the upper part of the thighs, the pain, however, returning
when he slackened it. This was of no use in the night The pains

^ ThispaUenfi lady had be^u undsr my care for.soiae miser

fie 'D0tf£OiniEUl) 81€» ITv

^dmiMfioed at the hip joint, and between that and tibe ankle fliere wu
nak an inch of the limb free from it ; and it was of an intensity that madd
the perspiiation stand on his face.

I have said there was a complication of irritatimi and congestion witiiin,
and I therefore treated the case partially for both. He was packed in
the wet sheet twice a day lor a week; the next week he was packed two
aoeeessive days and sweated the thirds and this was continued fbrneariy
a month. Meantime He had the cold i^iallow bath aftereach of the aboire
processes ; the dripping sheet once or twice in the day, according to the
unoiint of pain ; every other night he was fomented on the stomach for
an hoar at bed^inke ; he drank twelve to fifteen tumblers daily, and ate
sparingly ; his exercise was considerable, as the tic was quiet for houra
together, and did not interfere with his walking. This first month was
one of probation to him, for the pains were much increased ; but as I
had anticipated and told him this, his confidence and patience held out
against it. Still, for seven weeks, they were severe ; in the eighth and
math weeks they gradually diminished. In the tenth week of his treat-
ment a most extraordinary circumstance occutted. One night the paiaa
were terribly aggravated — almost as bad as ever ; he had shiverings, and
fdit altogether nervous. Ailer a few hours this was succeeded by an
excessive flow of pale urine, ihepmn suddenly ceased^ and he never had it
trfienoards! I have no doubt that, in this renewed disorder, there was
an efifort made by the viscera ; that efibrt produced the shivering and ner-
vousness, and resulted in the flow of what is called ^ hysterical mine."
It is quite certain, however, that the cure dates from that day : he never
had pain afterwards. It is necessary to state, that during the last five
weeks, he had been sweated and douched daily, besides a sitz bath of
half an hour, and large quantities of water : so that the stimulus of the
treatment had had fvU play. His spirits and general condition had im-
proved, but not sufficientiy to satisfy me, and I therefore detamed Mm
here a month sfter the cessation of the pain, and continued the douche
and other tonic treatment: but nothing seemed to elicit nK»e pain. I
look upoii this as one of the best defined instances of organic effixt on
the part of the viscera that coukl be produced, and altogether as an ex«
traordinary case.

Case XIX.— Tic Doulouxxuz of thb Face.
The subject of this case is a military officer, fifty-four yean old, of
amazing muscular power, which he has always been in the habit of ex-
ercising to the utmost, in bard riding, hard walking, and atUetic einr-
cises. He lived in the usual style of gentiemen of good rank and
fortune, dined on a variety of dishes, was fond of ail manner of cmidi-
ments, drank seven or eight glasses of wine at and after dinner, strong
cofifee, strong tea: but was not dissipated in other respects. A fo^
years back he had some mental distress. What I suspect to have taken
nkcefr^a: his mode of diet irritated an excitable itomaeh: hia ts

IM ITBOSAMIA— RMVB P^ftOI

nve eMicbeft irritated his spinal coid, tfae seat of the wiU} tte
fiNrmer played on the hitter, which was ready to receive imtatioo, and
the nerves of the left side of the face, proceeding from the spinal cord,
derived their morbid sensation from it when it was thus exerting morbid
sympathies with the viscera. The tic commenced about four years be*
fore he came to me, and was at first confined to the gum of the upper
jaw, left side, but gradually spread to the hp. It very often came with-
out any movement of the hp or jaw, but was sure to come with it, so
that eating was a serious operation for him. He underwent a variety
of treatments for it : and among others, an attempt was made to aepap
rate the nervous twigs of the gum from the main branch of the nerve,
by cutting down to the bone : this seemed to take the edge off the pain
for a period : but it returned as before. Homoeopathy was tried with
some success also : but several reasons obliged him to give it up. He
passed the greater part of the winter, 1844, on the shores of the Baltic,
in which he bathed daily. This bathing brought on diarrhcea and con-
siderable relief, in the midst of which he was called to England : ccm-
tinned his old plan oi diet, and soon got the tic as bad as ever. He
then came to me. All the signs of nervous disease of the stoomoh
vf&ce shown in his tongue, throat, eyes, sensations, &.c. : but his appe>
tite was good, which, no doubt, was the reason wherefore no restriction
had been hitherto placed on his diet, except by the homceopathic
physician.

His diet was immediately changed to the simple rtile of my estabUsh-
ment : and as his body had been well used to cold water, and was in
good condition, brisk treatment was applied at once. He was packed in
two successive wet sheets, morning and evening, with cold shallow bath
for six or seven minutes after each : and took the sitz bath for three-
quarters of an hour at noon. He wore the abdominal compress all day;
drank fifteen tumblers of water, and walked six or seven miles daily.
After a fortnight he took the douche for five or six minutes at noon, and
the long Bitz bath in the evening, in place of the second packing. Some-
times the packing was omitted altogether for two or three days, and the
douche taken twice. This was done in order to give respite from the
pain, which was roused each time he laid in the wet sheet. In fisict,
the phenomenon of increased pain to which I have aUuded in the text,
was very palpable in this gentleman, whose excellent reactive power
was thus exhibited. However, he was resolute, and did and bore every-
thing he was desired to do, and had his reward ; for at the end of four
weeks the tic was nearly gone. He went home for a few weeks, con-
tinued a modified treatment, but not the strict diet he had with me, and
the tic remained just as it was when he left me, now and then " sim-
mering." He returned for a fortnight, took to brisk treatment agam«
and got rid of the pain altogetlier. As easterly winds had always ag-
gravated, it, I recpmfuended him (it being the month of September) to
wpend a few weeks at some place on the Pevpnshire coast^imtU jim

VM omriiovmBvz, ate. 181

■Udle of October, aiul then to migrate to the south of Fmaee for tlM
ivinter, so as to establish the freedom from pain which his treatment at
Malvern bad effected. Since he left, he has sent me repeated accoimts
of himself, each announcing that ^* all is right ;" at which I rejoice, as it
speaks of the well-being of an excellent man and pains-taking patient*

It should be added that diarrhoea of two or three days, repeated
several times, was the only critical action that marked this case.

It must not be expected that all cases of facial tic are curable «
80 soon as this. In this instance much had no doubt been done
by the previous bathing in the Baltic, and its result in diarrhoea ;
and the constitution of the patient was excellent. Generally it
requires many months of assiduous water treatment to under-
mine this tedious malady : and in many cases it certainly fails,
though as oflen, I think, from the want of patience of the suf-
ferer, as inefiicacy of the treatment. Still, it does fail, and the
well-known case of a popular nobleman, who was a long time
under treatment at Malvern, is a notable instance of this ; he was
not one jot better. Altogether, it is the most inveterate of neu-
ralgic complaints.

Flying neuralgic pains of the ribs, especially over and about
the heart, of the fingers and arms, are always symptomatic of
passing increase of irritation in the viscera, and are best treated
with hot fomentations to the stomach, cold hip baths, dripping
sheets, or foot baths, according to the presence or absence of
mucous and feverish signs, the fomentations being most proper
when such are present, and the other means if they are abseni.
In violent fits of fixed tic, the fomentations, with copious water
drinking the while, are the best soothing remedy, and seldom fail
to alleviate, if not put down the attack. And this, which I have
proved in a great number of instances, forms a very strong argu-
ment for the origin of neuralgic ailments in the viscera. In like
manner toothache, which is very often a tic of the nerves of the

* I seize the opportunity of bearing this testimony to the fairness and
Implicit regularity of this patient, who will smile to see it thus recorded.
But most military men are excellent patients, and the physician m^y
always rely that his injunctions will be conscientiously fulfilled by them
The same applies to members of the Society of Friends, and, to a j^feit
extent, fo Scotchmen,— all three well regulated classes. They onif ten
know the comfort of having such patients who are troubled by th » j-^-
dolence, caprice, unreasonableness, and irregularity of the far gt>4^
number, who thereby gain no health for themselves and no credit £oi flt«
f^ttCffin.

teoUiy is relieTed by fomenting the stomach, foot-baths, and drini*

ing water freely. In all such cases the relief is owing to the
transfer of irritation from the interior to the exterior.

Neuralgia is for the most part, as I have said, a tedious malady
to cure. At thb moment, however, I have with roe a gentleman
who oflfers another exceptbn to this riile. A few words will tell
his case, its treatment, and the result up to this time.

Case XX.>— SaiATiaA.

The patient is thirty years old. For five years he has had severe
and increasing sciatica of the left side. Resident in Canada, he then
underwent all kinds of treatment, mercury, of course, in abundance, and
iodine, until his head and face swelled : he was poiscmed by it, in fitct
Besides this, he had been greatly given to spirit drinking. In Novem-
ber, 1846, he reached England, purposely to try the water cure, and
came under my care the latter end of that month. Betwe»i his landing ^
and his arrivil at Malvern, he was induced, during a short stay witb
friends, to try acupuncture : but the needles gave him exquisite torture,
and considerably augmented the neuralgic pain. In spite, however, of
the bad medicinal treatment he had undergone, his constitution, naturally
of the strongest, retained a good degree of vigor. Yet to look at him
when walking, bent almost double with pain and limping, one would
not have given much for his chances of recovery.

The action of the treatment in this case was immediate. He was
fomented at night, and packed in the wet sheet morning and evening for
an hour, with a cold shallow bath after each. He drank twelve to
fifteen tumblers of water, and lived on mutton, farinaceous puddings,
bread and butter. After two weeks of this, he was packed in two sheets,
successively, in the morning and one in the evening, with the douche
for three minutes at noon. He wore a compress all the time. For the
first fortnight, the pain was somewhat roused whilst in the wet sheet,
but subsided immediately in the shallow bath. In three weeks he felt
little or no pain at all, except when he sat down on the floor, and tried
to stretch the neuralgic leg out as straight as the other. In walking he
felt none, nor was any halt in his gait or any stooping perceptible : in
short, he declared himself in all particulars well, and that this sciatica^
which for five years had not only resisted all means, but increased not-
withstanding them, had in one month yielded to simple water. The
last I heard of this patient was, .that he was the most vigorous dancer
of Scotch reels at a party for that purpose ; this was three months after
his first coming to me.

Of Nervous Headache, the cause is still to be sought in the
viscera ; and the crises of the water treatment ^vhioh eSeet iliu

•

etm are all produced in them. Vomiting) ehronio relaxatkm of
the bowels, copious and loaded urine, attend its disa^^earance^
but never boils nor irritation of the skin : in many instances the
eause of nervous headache is to be found in disordered functioa
of the womb, and especially in excessive or difficult menstruation :
in these the stoppage of the excess, or removal of the difficulty,
are equivalent to a curative crisis. It cannot be denied, howeTer^
that this last class of causes renders nervous headache exceedingly
unmanageable, by this, as it is by all other plans of treatment.
The uterine organs acquire morbid habits of action, occurring
with periodical regularity, and it is difficult to break them. This
is more especially the case, when, with a proper amount of men-
struation, it comes slowly with pain, and is extended over eight
or nine days : these cases are often intractable. When the head-
ache b connected with excessive and quickly flowing menstrua-
tion, the water treatment is much more certain in its curative
result. Arising from any cause, nervous headache, which keeps
a fixed period of accession, is much less readily curable than that
which is induced at uncertain times by varying perturbating cir-
cumstances; once break the period, and you have it under
command. And in all cases the patient must have patience : like
other Uc diseases (for this is only a tic of the scalp) it is very
rarely cured by a coup de main : indeed, the attempt to do so by
urging on excessive treatment, more usually exasperates the
complaint : the phase of visceral irritation on which it depends is
so precise as to require the nicest adaptation of the amount of
stimulus applied. Moreover, this is eminently one of those diseasesi
the relief obtained for which from the water cure is more expe-
rienced after that treatment has ceased for some time, than in the
course of it.

There is the occasumal as well as the curative treatment of tic
of the head, or nervous headache. To subdue it for the nonce, a
cold dripping sheet, well rubbed over the body for three or four
minutes, and repeated every two hours or so, is, with some, a good
remedy. A cold foot bath for fifteen minutes, repeated every
three or four hours, succeeds with othqrs. The cold sitz bath for
twenty minutes, or more, is often successful. Finally, hot fomen-
tations to the pit of the stomach are of the greatest benefit, except
when there is excessive menstruation, in which event they are
inadmissible. In trying any of the above, it is necessary to drink
waiter more of less freely^ according to the fever present, and the

IM HBtTlULBIA — IfBBTS TASK —

•

nmoons sjrmptoms, and to frequently change the abdomuial oom-
press. We are often obliged to try one after another of all these
remedies. My experience speaks in favor of the foot baths and
sitz baths, in the greater number of cases : that is, where a tonic
eftect alone is required. Where, together with the nervous
symptoms, there is deficient secretion from the digestive mucous
surface, and constipation of bowels, dry mouthy hot breath, &c.,
attend, fomentations are preferable. The rubbing sheet is for the
slighter headaches. But packing in the wet sheet, sweating, and
the douche, are not admissible.

The curative treatment of nervous headnche is regulated, in the
main, by the same circumstances as the occasional. It is neces-
sary to ascertain the amount of secretorial disorder which is added
to the nervous ; how far mucous derangement, and feverish ex-
citement consequent on it, are combined with the nervous pain ;
and the condition of the uterine functions. Generally there is
much disorder of the mucous membrane in this chronic headache,
owing, very often, to the violent medicines that have been em-
ployed against it, and against the constipation of bowels which
almost as often attends. In this case, the partial packing with a
wet towel twice a day, gradually proceeding to the employment
of the sheet, should be used ; with the cold sitz bath for half an
hour, once or twice daily, the abdominal compress frequently
changed, and a somewhat copious use of water. The diet should
be chiefly farinaceous, meat being taken only twice or thrice a
week, and the exercise should be rather free than otherwise, pro-
vided the stomach digests a good portion of food. This sort of
treatment should be persisted in, until the reduction of the mucous
symptoms, for the most part announced by some internal crisis, is .
well established. In the course of effecting this, it is more than
probable that exasperation of the headache may occur, and espe-
cially immediately preceding some crisis of the bowels : for the
efforts of the body to that end are all made through the nervous
system, which is roused to them by the treatment. Accordingly,
when such occur and induce severe headache, the treatment must
be relaxed, or suspended for a few days or a week ; and the pa-
tient may be assured, meanwhile, that the pain is here of favora-
ble augury, certifying the active operation of the remedies. In
fact, if the patient is pretty strong, I generally recommend him
to bear with it for a time, because a continuance of the nervous
exoitem^t, of which it is a sign^ is piretty sure to^ terminate the

KERVOirS HEADACHE. 186

«ooaer In critical relief: but this requires discretion, s Supposing;
then, the mucous and feverish symptoms removed, and action of
the bowels obtained, the wet-sheet packing should be discontinued,
or only used now and then, as the pulse hardens and quickens
from the rest of the treatment. For a tonic and stimulating plan
is now advisable : besides sitz baths, the douche should be taken,
and gradually increased to several minutes' duration ; the shallow
bath in the morning should be had for ibur or five minutes, with
considerable friction ; foot baths should be taken once or twice a
day ; the dose of water should be free ; a small quantity of ani>
raal food should be given once daily, and a good amount of exer-
cise taken. Perseverance in these means at length causes either
a diarrhoea, or eruption of an itchy kind, in various parts of the
skin, with sometimes a considerable exudation of glutinous liquid
under the abdominal compress, which I have found to smell
strongly of medicinal substances long previously taken. But as
I have said, stoppages in the treatment are every now and then
necessary and beneficial.

When, with nervous headache, there are signs of obstructed
action of the liver, sweating will be required, with still a care not
to excite the circulation and nerves beyond the capabilities of the
organization, and any feverishness it may beget is to be subdued
by the wet sheet. And as regards the curative treatment gene-
rally, it must be remembered, that when a bad fit of headache is
on, it is to be suspended, and the occasional treatment already spo-
ken of employed. Scarcely any disease demands more attention
of the practitioner, in order to make minute changes in the treat-
ment, for. the great benefit of the patient, than this troublesome
form of neuralgia.

Arising from the phase of uterine irritation, which begets slow,
painful, or scanty menstruation, nervous headache is treated in a
very similar manner to the above. Wet sheeting and prolonged
sitz baths and foot baths are the principal remedies, and the douche
should not be applied without care ; for in these cases there is
frequently, besides Uc outside the skull, some fulness of blood
inside of it, in the brain ; for which reason, also, the quantity of
water should be carefully regulated. But where the pulse does
not indicate such fulness, the douche is a very necessary part of
the treatment ; and, played well on the loins, tends powerfully to
facilitate the uterine functions. The diet must depend on the
same circunostances of fulness of bead, or the contrary. But in

186 KEimALeiA — ^NSRTB PAtH —

Other case the ^eivise should be considerable^ for they both 4A
jfer from the instance o£ siippr^sed menstruation ftom aotiial
bloodlessness, of which I shall have to speak hereafter, and m
Which much exercise is far from desirable. It is scarcely nece»*
vary to add, that sweating is out of the question in the headai^
^hom the cause I am now speaking of.

In the contrary case, of nervous headache connected witk
e^xestwe menstruation, the tonic plan, and rest of the d^estive
organs and limbs, are necessary. In all exhausting losses of
Uood, nature, in order to save the vital <»rgans of nutrition, cod*
centrales the blood which remains about them, so as to obviate
the extinction of the being. Hence, with excesnve meostruatioa,
we constantly see inflammation of the stomach c(»ni»deiit ; and
hence also the necessity for avoiding stimulating or copious food,
although the body may be drained of blood at the very time*
But as food is to be very carefully taken, so exercise should be
carefully practised ; not only because there is small supply of
blood in the system, but because, whenever the will is exerted^
as in walking, there is a strain upon tiie nutritive organs, and
consequent increase of their congestion. So that we have abon*
dant reason for very careful dieting and for absolute rest, or at
jnost only passive exercise, in the headache connected with ex-
cessive menstruation. Inasmuch, however, as exercise is forbid-
den, so should the processes of the water cure be of a kind not
to require it ; and, in fact, those which are found practically to
be most efficient, require none, or at least very little, to cause
reaction. The sitz baths are very short, varying from two to
five minutes each, and taken three or four times a day. I have
often prescribed such in the midst of immense mens^ual dis-
charge, and always with decidedly good e^ct : of course they
are cold. A minute or two in the duration is of great importancei
as, if the patient be in the bath too long, it will rather increase
than relieve the evil ; and the colder the water the shorter the
time. Experience alone of the individual constitutions can aibni
a just notion of the requisite time and temperature. The cold
rubbing sheet is another remedy in the case in question. Water
should be drunk in very small quantities at a time, even so little
as a wine-glass full ; nor should the whole quantity exceed one
or two tumblers in the day. The reasons for low, farinaceous
diet have been given : ripe and Cooked fresh fruits may be taken,
as «lso succulent vegetables. Besides the most com|4ete real ef

APOPLBone wauam of thb bbjjdv, nto. m

ifedy which is attainable, it is a great point to avoid ^Kteroat
keat, and all hot liquids taken internally. Last, not least, as Ha
•Kcitahle character of woman is in this malady infinitely aug-
mented, it behoves to withdraw from the brain all subjects which
deeply implicate either its moral or intellectual faculties ; and^
however distasteful to feminine mobility, the patient must leant
to take things quietly. By such simple and negative means as
these, I have cured old standing nervous headaches arising from
uterine irritation and hemorrhage, when all sorts of medicinal
and dietede tonics, opiates, and astringents, had altogether failed.
I have dwelt somewhat at length on this malady, because it is
of so frequent occurrence, and because it is not my intention to
iltastrate its history and treatment by the detail of cases. It is
one of those diseases of which it may most truly be said that
no two cases are alike; of which, therefcnre, no pictura could ba
given, by one or twenty cases, that should be a practical guide ;
so much does the mani^ement of each one depend on small points
which appeal to the tatuUiony rather than the bare observation of
tile i^ysician. Meanwhile, it may be ccmfidently stated, that
nenxms headache is one of the maladies in which the judicious
use of the water treatment is most effectual.

§ 8. Apoplectic Fulness op the Brain — Congestion op th«

Bbain — Palsy.

»

In the preceding nervous complaints, the diseased circulation of
blood in the substance of the nerve-matter was not of a character
to disorder its functions by obstructing it ; neither have we direcif
tangible evidence of excess of blood in it as the essential of their
presence, although, reasoning on sound physiological grounds, the
inference is inevitable. In the disorders which head this section,
however, there is every evidence that excess of blood, in a vary,
ing degree of sttms or congestion, exists — a congestion tending to
impede the office of the brain and spinal cord, and their com-
mands to the muscles of voluntary action.

The manner in which apoplectic fuheas and congestion of the
brain are generated, has been already sketched (page 18)»
Originating in stomach irritation alone in the first instance, it is
a simple extension thence to the brain ; but when mental causes
have been at work, the shock or strain on the mind's organ, "the
hmm. la ivverberated in the digestive organs; an irritation is aet

/
I8t ▲POI'IJBCTIO VQLNSSS OF THB MUJNy »tQ»

up there, plays upon the already predkposed hndn, and
chronic fulness of the latter is established, which, as might be
expected, is of a more inveterate character than when the fault is
all in the stomach. The man who has few mental cares or UhIs,
but who gives his stomach a great quantity of work, will get his
head too full of blood, and the fulness will be, in a great majority
ef instances, of the apoplectic kind ; whilst he who drudges with
his head, swallows his food without chewing, or eats very little,
and perhaps takes stimulants to carry him on in his labors, will
have fulness of the head too, but it will be of the congestive kind*
The difference between these two is, however, in degree only ;
and the patient sometimes passes through the apoplectic and sub-
sequently reaches the congestive stage. In both, the blood*vesseb
of the substance of the whole brain contain too much blood ;
but in apoplectic fulness they still retain a considerable amount of
their vitality and contractile power, and there is not only too
much blood, but it is passed through it with augmented rapidity.
In congestive fulness, on the other hand, the blood-vessels hav^
lost their tone more completely, and the blood is not passed on
rapidly. But as the distinctions between these states have a
most important practical bearing, I will endeavor to render them
clear by placing them in a tabular form : —

APOPLECTIC FUIiXESB, CONGESTION OF THE HEAD.

Occurs in* persons having a general Persons of meagre habit and ex-
fulness of blood, and who make that treme nervous action, both of mind
fluid rapidly ; who have great ap- and body, whose tendency is to keep
petite for food ; and in whom there both on the stretch, and eat not in
18 often hereditary tendency. Causes proportion to the waste incurred,
are, excessive feeding, stimulating are the most subject to this state,
diet, alcoholic fluids, want of exer- Causes are, excessive action of tii«
cise, long sleep, hot rooms, sensual brain and spinal cord in mental ex-
indulgence ; tonic medicines, especi- citement and venereal pleasures;
ally iron waters. alcoholic stimulants, and small
Symptoms are, turgid and red, or quantity of, or improper food being
pufl^ and pale face, projecting eyes, taken at irregular times, and eaten
greasy skin of the face, whizzing quickly ; tea, coffee, and other hot
noise in the ears, flashes of fire be- liquids ; want of natural and rega-
fore the eyes, giddiness, and tight- lar sleep; tobacco smoking and snuff-
ness of head ; sometimes very bad in^ ; losses by purging, bleeding and
headache, fiery red throat, furred and urme ; mercury and iodine,
red-tipped tongue, feeling of chok- Symptoms. Colorless or dirty>
ing about the throat ; thirst, great looking and anxious face, eyes sunk,
appetite, constipated bowels, but humnimg and singing noise in the
largely opened when they act, and ears, dulness of heanng and sight
of dirk color ; urine scanty and high the latter being often clouded by a
colored ; seldom any pain or other cobweb or dark spots ; giddiness and
Mnntion in the abdomen \ tender- fiiintne8«».senM of weakneas m tiie

APOPLECTIC PULNESS OF THE BRAIlf, ETC, 189

at the pit of the stomach occa- head, red and swollen tongne, re-
•ionallj ; breathing strong and laxed throaty no thirrt, appetite of*
wheezmff, pulse large, hard, throb- ten small, more or less distress after
bing, rather slow, frequent palpita- eating, bowels constipated, but
tion ; strong tendency to sleep, great quantity to be eraciiated smalls
impatience and irascibility, restless*- urine copious and clear, especiallj
Hess of mind as to subjects; hot sVi\), at ' ni^ht, nocturnal emissions;
» 04 small fuaeeptibility to exAfTMl breathing weak and slow, sighing or
f nld . yawning* pulse small, soft, and often

slow; but little sleep, and broken
and dreainy; mind depressed and
moody ; no desire for exercise, and
the limbs soon tired ; skin cool and
bloodless, feet icyi great suscepti-
bility to external cold.

• lliese are wide diflferences, and fktal ones, to those who treat
« <^aine instead of a condition, who would bleed, or otherwise
•e<i*ice for a " fulness of the head," without inquiring whether
tot means "apoplectic'* or " congestive" fulness : many is the
unfortunate, it is to be feared, who has passed out of the world
\fter a bleeding, who might have been kept in it with nutritious
f)od, and rest of the nervous centres. But although the causes
nnd symptoms, and, as will be presently seen, the treatment of
^ese states differ, they nevertheless tend towards the same end,
Vleft to themselves. The fulness constituting the apoplectic
tendency terminates in sudden pressure or effusion of blood on
the brain, with apoplectic stupor : and the patient either comes
out of this with more or less palsy, or dies, the palsy sometimes
<^radually disappearing. In the fulness which I have called
congestive, the enfeebled and gorged blood-vessels of the brain
((radvaUy press more and mofe upon its matter, oppress its func-
tion, and finally induce faUy of more or fewer muscles, but
without any such suspension of consciousness as that which
attends apoplexy.

Thus, then, the matter stands : — In apoplectic fulness there is
excess of blood in the body generally, and in the brain in par-
ticular and d fortiori ; for, even in health, that organ receives
one-fiflh of the whole blood of the body. The vessels of the brain
not only contain too much blood, but that blood is circulated with
a rapidity and force, that renders sudden extreme pressure or
rupture of them very probable. Moreover, the body is in a high
gtate of nutrition, the blood-vessels themselves are highly nour-
ished, and therefore, although containing too much fluid, have not
80 much lost their contractility, and are not in the state of extremt

Iff AFOTLscTic Tvvanm of tbs iiaAOiy btq.

i^d fttoDic lelazation, as in the oongeftiTe state. AcooidiDglj^
all tiie pheoomena aie those of ezoessive actiopy as will resdiif
be seen in the above tabular view. In congestive fulness, on the
otbex hand, there being rather a paucity than an ezoess of blood
m the entire frame, nature, acting by her invariable rule, sends
the greater portion of it to the centres of life in the akwnaeh.^ad
the brain. But as in that case nutrition of the blood-vessels is
below par, they offer little vital contractile resistance to the blood
that oppresses them, and the circulatuMi in the brain is thus eiu
ibebled, stagnant, congestive, with slight chance of causing sud»
den, but with every probability of inducing gradual pressure of
theoigan* The same deficient nutrition obtains in the heart,
which therefore fails to cUive the blood to the head vehemenlfy :
find thus between the deficient blood, its congestion in the brain^
and pressure on its i^ervous function, and the general deficient
nutrition as a consequence of both, the phenomena of this ooi^
gestive fulness of the head are those of enfeebled action, as thf^
table exhibits.

In a patient suffering with apoplectic fulness of the head, whafe«
ever suddenly reduces the general and local repletioq, iaige blood*
letting, purging, sweating, or the immediate and ooo^^lete with*«
drawal of all stimulus of food, is apt to cause a transition frook
that kind of fulness to the congestive. The rationale of thisia
sufficiently obvious from what precedes : the sudden reduction of >
stimulus, and of the vital fluid, takes from the vessels of the brain,
their contractile energy, whilst the same reduction causes an un»
due proportion of blood to centre in them, and this eJM^ess and,
their relaxation constitute the congestive state. This is constantly
occurring in consequence of the rough practice so commonly em*
ployed against what is called << determination of blood to the^
head." But without that, the same transition is liable to take
place> If apoplexy does not happen, the rapid action of the di-
gestive organs at length passes into feverish acticHi, the appetite^
diminishes, the blood wastes without being renewed in {vrqwrtiiOfit,
and the vesseb of the brain undei^ the same changie as if suidU.
den reduction had been ejected. If apoplexy does happen, the
means usually taken, and the starvation that follows, the attaok^
serve in like manner to convert the apoplectic into the congestiv#|
state. Now, this transition state js often [Hresented for treatment^
9fhi requires considerable acumen, both to detect and to treat— ln^
s||eer between the tonic and the depleting plans. The ^^tm^»i&

ABoriiaeno fvutbu ^ tke beaim, me* Ml

liffi of iTfiniitoiiis alt^ady given will eoabld the praedtloMr to
DjVpeftain the pfepooderaoce of one or other oofiditioOy and hit
n^medies must be applied accordingly-.

'When the state of apofpUcik fuine^t is to be combated, we musl
have reooarse to the towering processes of the water ovrs. Hoi
faosentations to the abdomen, the constant wearing of the abdc^
minal congress, packing in the wet i^eet, the long sitz bath, low
diet, and strong exercise require to be used. But the tempera^
taure qS the ibmentstione should be regulated by the pulse ; if thi«
be i»e/y hajrd and bounding, they should be moderately hot, and
may be iooressed in heat as the pulse becomes softer. The wetr
ith^t packing, too, must be regulated by the pulse and the sensa*
tijCKis in the head : and the patient ought not to remain more thaa
thirty to forty minutes at a time in it, if the former be very hard,'
and the latter distressing from giddiness, great noise, &c. ; it ie
nwH also to have a cold wet doth on the head whilst in the sheet.
in the cold shallow bath which follows it, the head should be first
wetted, and a pitcher of cold water poured over it; and thia
should be ^repeated twice or thrice during the bath. The fre-
q«ieticy of the sheet will depend on circumstances, to be men*
tioned presently. It is as well to commence the sitz bath at
about W<^ or 65^, and gradually reduce it: the duration of it
^wttld be fnxn thirty to forty-five minutes, and a cold wM; clotl^
shottH be worn round the head whilst in it. The diet should be
g«c»k^y predominant in vegetable matters, animal food being
taken only twice or at most thrice a week, and of some of the
least stimalating kind, such as chicken. And ftsthe objected
such <Het is to rediKse the quantity and stimulating quality of the
bkod made, so is the strong exercise intended further to w^e it:
as it is formed. There can be no doubt that the bulk <^ eirqu*
lattag fluid adds to the laborious character of the circulation, aiKl
also quickens the activity of the functions, of th6 nervous parti«,
eulaiAy : and on both these accounts it is desirable to avoid mucli
water-drinking in ^is kind of fulness of head: in faet^ext^pl
to-qneisch the thinst, the less water is drunk the better.

MTfaese means fulfil the intent of reducing the mass of. Mood
generally, and in the head in particular. But a body in this stalSf
nnst not be rudely handled by the water plan, any more than by;
the* medidLoal plan. If it be attempted to hurry on the procesa
d feTOdnc!twri,> ope of two things is lii^le to happen: either th»
fci pi f i prooeesee^Micite the nervous system, before the quanti^

193 APOPLBOtfC VmMMBB OP TBE BBAtlt, BfO.

of circulating blood is reduced, and thus endanger the brain, thttt
is the subject of treatment ; or the reduction being suddenly made,
the apoplectic is changed for the congestive state, by the means
already stated. So that the more full the head, the more care-
fully should we proceed in the endeavor to empty it : in this, as
in so many other instances, the physician's best part is patiently
to watch nature's steps, and have a care not to exceed or hasten
them : the circulation should be carefully watched, and any the
least augmentation of it, in the form of nervous pulse, or any
other nervous sign, should immediately make him pause Ibr a
time, and relax the treatment. The pulse should be examined
daily, before and after the wet-sheet packing, and the quantity
and the frequency of the latter regulated accordingly ; few will
bear more than two packings in the day : most persons not so
many. Fomentations, also,, if too hot, or too often applied, make
the head throb instead of quieting it. Both these being power-
fully and positive lowering remedies, aid the negative depletory
measure of diet recommended, and if all be judiciously employed
they form the most certain m^ans of permanently relieving the
apoplectic head, the long sitz baths, meanwhile, drawing the blood
downwards from it.

Under the most favorable circumstances, however, nervous signs
appear m the course of the treatment ; indeed, they are indicative
of the passage of the cerebral fulness from the stage of oppres-
sion to that which is coincident with irregular function of the
brain ; but if the tremors, fears, &c., are very distressing, all
that is required is to relax or suspend the treatment for a time.
The sleep, too, from being excessively heavy, becomes brokm
and dreamy : this acknowledges much the same cause as the
nervousness, but needs not any great attention. As the braiti
empties, the circulation in it becomes more steady, and all these
symptoms dwindle down into quietude. One striking fact is, that,
whereas the patient had never before experienced any dyspeptic
uneasiness in the stomach, he now, as the head becomes more
light and easy, for the first time discovers that his food disagrees,
by a sense of heaviness, distension, &c. This is explained by
the oppressed state of the brain, which had previously rendered
it insensible of the irritation going on in the digestives, whose
morbid sensations come to be appreciated when the brain is reco-
vering its activity, by the withdniwal of the load which oppa^sid
K Much grumbling do.palienta mske at MSf to ihim^t

^mxQwnm Fuucass or tbb BiAnf, wk. ^IW

aym } i <om : iHit they should welcome it, were it for no other reaaon
than that it lays open to them the origin of their perilous malady
of the head in the digestive organs, and tacks a dietetic moral to
the history of their complaints.

In congestive fulness of the head, contrary indications of treat-
ment arc presented to those just considered. Here the object is to
give tone to the blood-vessels of the body generally, and of the
brain in particular, so that these last may contract and rid them-
selves of their load. As in all exhausted states of the nutritive
organs, so in this there is congestion of the digestive apparatus as
well as of the brain : hence the imperfect digestion and blood-
making, and the want of tone in the solids. To relieve the con-
gestion of the apparatus in question, to obtain good blood from
better digested food becomes, therefore, the primary means of
giving tone and contractile energy to the blood-vessels : and whilst
blood is thus being made, a simultaneous aim should be to dis-
tribute it equally to the surface and the interior, and thus to free
the latter from its excess.

For these purposes, in a case of pure congestion of the head,
rubbings with tl^e dripping sheet should be first used several
times in the day ; then the cold shallow bath every morning, with
one or two sitz baths of ten minutes each daily ; foot baths of eight
or ten minutes, at any time of the day, are desirable ; the bompress
should be worn all the day, and changed three or four times ; the
quantity of water drank should be very gradually increased,
until it reaches, eight or nine tumblers daily. The diet, mean-
time, should be such as nourishes, without ofiending the stomach
by its bulk ; and therefore bread, the highly nutritious farinacece,
and meat, should chiefly form it ; nothing is so bad for the
stomach of one with congested head as large masses of vegetable
'feed ; they distress and oppress that organ, and heat of head and
harass of mind immediately follow. Moreover, as the object is
to restore tone to the blood* vessels, the diet which contains the
gareatest amount of nutriment, without being actually irritating, is
the best, affording, as it does, the most nutritive blood. The
duration of the above treatment will depend much upon the reac-
tive energies of the patient, which, in tibis malady, are often at a
low ebb. But when, from the pulse, the skin, the s^sations in
the stomach, ^bc, it is inferred that the congestion about the
ilOHmoh is diimnished, and the powers of nutrition increased, the
^jftwtweal mf^ be augnoMted in pioportion. The shallow b«A
10

Iti COHGBtnTB WVLSfWOS OF TBI BSADT) B«B*

dioaU bft extended in time, and more eflfusioii oa the head and
more general friction practised ; the sitz baths may remain as
befturei unlesn there be great constipation, when they may reach
twenty to thirty minutes. It may be expedient, also, at this pe-
jriody to substitute a small douche for one of the sitz baths, and
gradually increase the length of it ; and, when the patient is able
to take it for two or three minutes, to submit him to a larger and
heavier douche. The foot baths will be found still of much use :
they relieve the tightness, the darting pains, the fixed headache,
and the fidgetty stale of mind which so commonly attend cerebral
qoogestion. Bad sleep, another accompaniment, may be often
cheated by a short sitz bath at bed-time. In case of intense dis-
tress, or even pain at the pit of the stomach, fomentations of mode-
rate heat over that part are useful. The pulse being verysmcdl
mid weak, the skin cold and very inactive, and the tongue moist,
it is necessary to put the patient in the sweating process now and
then — ^twioe a week, perhaps. As the object of this is only to
give some artificial aid to the efibrts of the interior organs to send
their blood towards the exterior, and to rouse them generally, the
appearance of moisture on the skin is sufficient evidence of such
efforts having been successfully made ; and it is unnecessary,
and indeed would be harmful, to urge the process further. But
in some cases it is not needed at all ; and when it is, a prolonged
cold shallow bath should succeed it. All these means require to
be modified in period and duration, and sometimes to be sus-
pended, when there is reason to think that they are too much £>r
the reactive power of the system. In no diseases, so much as in
these head affections, is it requisite to calculate the capacities of
the body, so that no remedy shall oppress, instead of aiding them
in their strivings towards restoration ; and in no way can this be
so safely done as by commencing very gently with the minor tonic
appliances of the water cure, and as gently increasing their
strength, until the frame reacts healthfully up<» a long applica-
tion of the douche, or a shallow bath of six or seven minutes'
duration. Should the eflS)rts of the body, at any time during the
treatment, generate feverishness of mouth, pulse, <S^c., a. towel or
partial wet-sheet packing may be necessary ; though, as a con-
tinued remedy, it is not indicated.

.. The amount of water to be drunk aa a nice matter in this dls-
oider. .Connected, as it for the most part is, with intense ^veiwoiw
y Urge quantitiea of water are tnadmis8ible». espedaUy jii

OOVOBSnVB PULIflSS OF TBB BEAOfi fflC. MS

the onset. As the circulation and blood-making improre, the

quantity should be gradually increased. Further, it often hap-
pens that the shock of half a tumbler of water, cold from the
spring, upon the stomach, produces immediate tightness and pain
in the head, particularly at the early stage of the treatment; and
I have found all inconvenience of this sort obviated by the simple
contrivance of raising the temperature of the water to 60^, until
a better state of things is established. Very heterodox this, I sup-
pose, with those who follow the Grerman track, and cannot think
for themselves ; but it is good policy, notwithstanding, to avoid
disagreeables, even though the road be thereby made somewhat
longer, of which I am by no means sure in the present instance.

A similar rule of gradual increase applies to the exerdte of
patients with congested head; the reason for which has been
more than once given in preceding pages. As the blood-vessels
of the brain and spinal cord gain in tone, and the whole circula-
tion improves in strength, the amount of active exercise may be
augmented ; but at first it should be as small as may be, or even
confined to the passive kind; generally, horse exercise is the
best.

With these indicia regarding the treatment of the two kinds of
brain fulness, it is unnecessary to enter upon that which is fitted
for the state that partakes of both. I have had such under my
care, and have ibund it a most difficult thing to manage, as may
be imagined, when it is considered that the blood-vessels are in
the mezxo^temdne between excessive and deficient nutrition, and
when that which is adapted for one is unfitted for the other. The.
general plan in these cases is, to use the wet-sheet packing alter-
nate days with the shallow bath, and to have the sitz baths daily ;
inclining, upon the whole, rather to the tonic than the lowering
applications; with, perhaps, the exception of the diet, which
should be rather on the side of fasting than feasting. For the
rest, the physician must exert his power of discrimination : and,
doing so, he will find this mingled form of brain-fulness a much
less tedious malady than the purely congestive state, though more
so than the apoplectic. Indeed, pure atonic congestion of the
brain is, in its treatment, one of the most trying tilings, both to
the patience of the doctor, and the faith of the patient. Yet it is
one pf the most; common in this land of anxious heads, and achixig*
beaM» and sordid scrambling.

19t APOPLECTIC FULNESS OF THE BBAIN, ETC*

Case XXI. — ^Apoplectic Fulwkss of the Head.

The patient is a gentleman of forty-six years, who for some years had
done all he could to fill his body generally, and his head in particnlar,
with blood ; he had eaten and drunk more than was good for his body,
and not had care and anxiety enough of mind to mortify it. He had
been plentifully bled, purged, blistered, &c., but the causes had not been
removed ; therefore all these means were unavailing ; on the contrary, he
had been ordered by his medical attendant to take first one pint, and then
one bottle of sherry daily ! He came to me, weighing nearly seventeen
stone, although a short person, with a turgid face, bounding pulse, fiery
red and furred tongue ; his sensations of pain, giddiness, swimming, &c.,
in the day, were bad enough ; but it was at night that his chief miseries
came on. He got to sleep well enough ; but horrid dreams presently
began, with startings and nightmare ; he awoke biting his tongue, with
the saliva pouring from his mouth in large quantity, numbness of the
limbs, and fear of immediate annihilation. In the day, too, there was
frequent numbness of one or more limbs. Altogether, his life was one
of fear and misery, and of unquestionable peril, for apoplexy was immi-
nent, and might take place at any moment.

As he lived only five or six miles from Malvern, he proposed to come
.and see me frequently, and carry oniiis treatment at home. This was
not very prudent, but relying that he would strictly follow my directions,
I consented to the arrangement. I ordered the wet-sheet packing once
a-day, with a cold shower bath after it. He wore the abdominal compress ;
the water he drank was not to exceed five tumblers daily ; his diet was
reduced to a small quantity of animal food every other day ; bread and
butter, &rinaceou8 puddings, green vegetables, and water, — nothing
more. He took abundance of exercise. He came to see me several
times, and announced a calmer sleep altogether, though still much dis-
turbed. He got to take two wet-sheet packings in the day, and fomentsr
tions at night for an hour. The bowels were becoming relaxed, and the
kidneys were acting with extraordinary energy, although when he came
to me a tearcup full of blood-red urine was all he passed in each twelve
hours. He was thinning under these excretions and the diminished
supply of stimulus and food ; still he was nervous and hypochondriacal,
and gave signs which showed that congestive fulness of the head had
been established. It was plain that the lowering process was going on
too fast, and I therefore diminished the whole treatment, and tie quantity
of water especially. He went away, and I saw nothing mqre of him for
four or five weeks. At the end of that time I rode out to see him, and
was astounded to find a perfectly lean man, with abundant wrinkles,
where all had been to the last degree turgid. In fact, he told me that,
* from the time of his first consulting me to that date^-^bout nine weeks
—he had positively lost five stone weight. He further told me that,
after last seeing me, he had gone or. packing and fomenting at the rate

APOPLECTIC FULNESS OP THE BBAIN, ETC. IfiV

of twice a day, had taken an enonnous quantity of exercise, and dmnk
an enormouB quantity of water ; that, in short, as regarded this beverage^
he had become infatuated, just as drunkards are with alcoholic drinks;
that he had got up at night, when not thirsty, to take it, — an irresistible
desire for it, as for a stimulus, seizing him, that when his wife remon*
strated with him on drinking so much, he had even taken it furtively,
unknown to her, and that the fear of my interfering with it had prevented
his coming to see me. Meantime, however, his nights had materially
improved ; the nightmare was gone-— the startings almost so ; he rarely
bit his tongue, and the nightly salivation had stopped. The bowels and
kidneys had continued to act briskly, and his appetite was great But
bis hypochondriacal state had very much increased, and his nerves were
quite shaken. Warning him on the folly of what he had been doing, I
desired him to leave off all treatment except the shower bath in the morn-
ing, to take as little water as possible, to enter upon a full animal diet, to
walk less, and to amuse his mind by travelling about. He did so, and
gradually got round ; but it took nearly twelve months to recover his
nervous firmness. Recover it he did, however ; and at this time, more
than two years since he consulted me, he is one of the healthiest men
alive, without a single bad symptom about the head or any other organ,
weighing between twelve and thirteen stone, eating as others do, drink-
ing two or three glasses of wine occasionally, and a tumbler of bitter ale
every day.

The rationale of this case and of its treatment is as follows.
The patient, instead of allowing me to see him frequently, and
judge of the progress of his malady, took upon himself not only
to continue but to increase the amount of treatment prescribed
by me. The Continued packing, the low diet, the excessive
exercise, and, above all, the enormous quantity of water he
drank (fifteen and eighteen tumblers daily), all conspired to
quicken the process of waste in the body, much more than was
proper. In fact, this waste was so great as to require constantly
the stimulating power of the water, to which he had recourse in
the manner I have described. The too rapid declension of the
body thus induced, proved a shock to the nervous system, en-
feebling it, and bringing about the hypochondriacal state alluded
to. The same sudden declension of organic vigor drove the
brain from the apoplectic into the congestive state, the utmost
amount of relaxation having possession of the cerebral blood-ves-
sels. So that when I saw him after an absence of several weeks,*
what his nervous and other organs wanted was, rest from ezces--
sire action, and tone, as I have already laid down, as essentia]

IM AFOPLSCTIC FVLNESS OF THE BBAIN, BTO.

ftr congestion of the head. The patient accordingly took a
shower bath daily, more and stronger food, less exercise, and
Very little water, adding to those the genial tonic of change of
scene and circumstance. Having a good constitution to go upon^
this succeeded, although it took a long time. Had he been
guided by me from the beginning, seen me oftener, and had hia
symptoms closely attended to, and his treatment modified accord-
ing. to them, he would have reached the point of health he now
possesses without the peril and disagreeables he passed through.
But whilst this case shows the danger of using the water treat-
ment without advice and discretion, it also exhibits the very great
power it includes of permanently reducing a condition of brain,
which all other modes of treatment only relieve for a brief period,
and which in this case had not been relieved, even for a short
time, by any of them.

Cass XXIL — ^Apoplectic and Congesttve Fulness of the Hbad-^
Deafness — ^Intense Headache.

For several yeai:s, a lady, of forty-eight years of age, had been subject
to most distressing and alarming head symptoms ; intense, prostrating
headaches ; giddiness that caused her to reel ; bursting sensation of the
skull ; violent and irritating noises constantly in the head. To these
were added, great nervousness, bound bowels, scanty urine, constant fe-
verithness, vehement flushings of the &ce, ice-cold feet The pulse Mras
large, bat yielding and mOst irregular ; appetite small ; sleep very much
disturbed. She had undergone violent medication at the hands of the
first metropcditan and provincial authorities, whose object appears to
have been to derive powerfully from the head, by such remedies as five
grains of calomel at night, with some drastic draught in the morning ;
whilst little attention seems to have been given to the diet. However,
between the original malady and the excessive irritation set up by the
medicinal treatment, the nerves, both ganglionic and cerebral, and their
csntres, were in the most alarming condition.

All the symptoms evidenced that middle state of the cerebral blood-
vessels which I have mentioned as the transition from the active' fulness
of apoplectic to the totally passive fulness of congestive disorder, and to
the difficulty of treating which I have alluded. Accordingly, I com-
menced the treatment very carefully. The details are as follows : —

August 1st. — Hot fomentations to the abdomen for an hour at bed-
time ; the flannels changed every ten minutes, and a wine-glass of cold
water drank. at each change. Damp compress on the bowels, to be
worn night and day. From three to four tumblers of cold water during

AVOPLICnC FDLNBS6 OF THS B&AIN, CM. IM

the day, to be taken in small quantities at a time. -Braakfiut ef eoU

toast •nd a little batter ; no liquid whatever. For dinner, three onncee
ei animal food — mutton, beef, poultry, and game, three times a week,
with as litUe liquid as possible. On other days, the dinner to consist of
a cup of cocoa, with cold toast and butter ; or of some &rinaceons
padding, eaten neariy cold. Very weak and almost cold black tea in
the evening, with cold toast and butter. The pulse becoming less hard
and bounding under this, I proceeded with more decided treatment

4th. — ^Packed in wet sheet for an hour before breakfiist Dripping
sheet after it All the rest as before.

6th. — ^The same, except that the shallow bath was used instead of the
rubbing sheet after the packing. The patient remained four minutes in
it, was wc 11 rubbed, and had water repeatedly poured over the head.

- 9th. — Sitz bath at 70^, for a quarter of an hour at noon, was added to
the above. Did not agree ; headache came an hour or two after it

12th. — ^Packing and shallow bath before breakfast ; a foot bath of cold
water, with some mustard flour in it, for ten minutes twice in the day ;
fomentations at night ; abdominal compress ; three to four tumUers of
water. This was the treatment up to the

27th. — The head sufl^ring a good deal, ordered foot bath of mustard
and water ; also that the nape of the neck should be rubbed for fifteen
minutes with the same mixture. Head immediately relieved. This in-
stead of the packing.

28th. Packing as usual. Three foot baths in the course of the day.

September 2d. — Pulse considerably reduced by the long-continaed
packing, fomentations, &c. ; somewhat inclined to hysteria, too. Ner-
vous headache. All these signs indicated that the lowering process had,
for the present, been carried as fiir, or at least as fast, as the system
could bear. Therefore, on the

3d. — ^I only (»dered the cold shallow bath before break&st, with the
foot baths as usual.

4th. — Shallow bath on rising ; foot baths as usual ; sitz bath at noon
for half an hour. Rode out in a wheel-chair at two o'clock for an hour ;
came home and vomited copiously until five o'clock. Here was the be-
ginning of an inlemal crisis, which the packing, fomentations, dltc.» by
removing the irritative state of the internal organs, had enabled them to
efiect The nervous condition of the 2d, was the symptom of the com-
mencing efEbn which terminated in this manner. The matter vomited
consisted of a large quantity of clear, frothy mucus, mixed with an equal
quantity of a black, tenacious, and heavy substance. A cold sitz bath
for a quarter of an hour after it, and fomentations at night, removed all
traces of the emetic tumult.

6tb .^-Shallow bath in the morning ; foot and hand baths three times
in the day ; sitz bath for half an hour at noon, and a quarter of an
•%ar at five p.m. Discharge of blood from the bowels in the i

900 A70PLBCTIC FULNBS8 OP THB BBAIN, JRO.

^-another chancter of the internal crUia. Head altogether free bom
pain ; and she said she felt lighter and better than she had ever done.

6th. — Treatment as above. Fomentations at bed-time ; walked more
than half a mile steadily ; much better to-day. In the coarse of the
night colicky pains, followed by free diarrhoea, the bowels acting twice.

7th. — Treatment the same. Walked ; and then drove out for an hour.
Felt better than she had done from the beginning.

8th. — Nothing bat shallow bath. Bat as she became languid from
going to church, she took a foot bath, which soon restored her. Quite
well in all other respects.

10th. — Some little feverish disturbance induced me to order a packing
to-day. Foot, hand, and sitz baths as before. Head became Inid from
too long a drive. Fomentations at bed-time.

11th. — ^After a good night felt well; ordered foot baths. Suddenly
seized with copious vomiting and purging. Took sitz bath after them
and went out, quite well.

13th. — ^Walked out twice, and drove once. Packed in the morning
m wet sheet. Two sitz and two foot baths, and several hand baths in
the day. A considerable quantity of blood passed from the bowels.

16th. — Sick again.

19th. — ^Head for the last week perfectly well, and admitting of a good
amount of exercise. This day, however, she overdid it, and the head
became bad in the night. Had not packed for three days, but, on ac-
count of the increased headache, she on the

20th, — ^Packed ; did not walk out at aU ; took one foot and one sitz
bath, and a drive.

From this time to the 24th, when this patient left Malvern, she conti-
nued to take the shallow bath in the morning, two foot baths, and two
hand baths. Throughout the latter month of the treatment, the vomit-
ing and purging, with occasional discharge of blood from the bowels,
continued in varied degree ; but I have only noted the days when either
of these was excessive. Fomentations were frequently employed at
night for twenty or thirty minutes, accoriding to the transitory condition
of the head ; when it was worse, with increased strength of pulse, they
were used ; when it was bad, without that sign, additional foot baths and
sitz baths were beneficially taken.

This lady left Malvern on the 24th September, taking with her the
following directions to be pursued at home : —

" Shallow bath at 58® every morning for two minutes.

Two foot baths of ten minutes each in the course of the day.

A sitz bath at 65^ for half an hour every other day at noon, or any
time three hours after a meal.

Wear the compress all day.

It would be well to pack in the wet sheet once a week or so^ with thv
•baUow bath as above ; but if all is right in the head and bow^Ia— thil

170PLECTIC FVLNBSS OP THB BRAIN, BTC* 201

fa, if the head is free from heat and pain, and the howelfl suflElciMitly qpe«
—omit this.

' Vegetable diet, except three times a week, when animal food may bs
taken at dinner."

The deafness with which the patient was afl^ted varied in the course
of her treatment at Malvern, but, on the whole, diminished so much that,
by the time she left, she could hear perfectly well, if too many voices
were not crossing each other at once. Perseverance in the above direc-
tions at home completely restored it.

It should be recalled that, previously to trying the water treatment, this
hdy, whose positfon in society is high, had been rendered incapable of
entering it ; the excitement of the smallest reunion was too much for her
head ; besides which, the headaches were so frequent and so intense, that
she could form no engagement with the smallest certainty of being able
to fulfil it ; withal, her increasing deafness was daily rendering society
impossible and distasteful to her. Neither could she find pleasure in
travelling ; for ten or twelve miles, in the easiest carriage, was more than
she could bear in one day. But after going through the above treatment,
all this was changed. Her headaches had gone — gone so far, that be-
tween September, 1844, when she left Malvern, and May, 1845, when
she returned, she had not more than three attacks for a few hours (in-
duced by mental excitement), and of a vastly mitigated character, instead
of one or two bad attacks every week, and more or less of it every day.
The restoration of her hearing was her restoration to society. And the
certainly she had that, at any time when the head had been tired by talk-
ing and listening, she could put herself to rights with a wet sheet and a
foot bath, rendered the life worth possessing which had been for a long
time previously intolerable. In this altered state of circumstances she
passed through the winter of 1844-45. In the month of May of the last
year, a considerable amount of mental excitement, experienced whilst
undergoing the physical excitement of travelling from place to place,
added to irregularities of times of eating inseparable therefrom, brought
back some of her ailments ; that is to say, some degree of flushing, and
a considerable degree of deafness ; in all other respects she remained
well, showing the partial character of the mischief. Still, the causes
had been re-applied, and the eflects were inevitable ; and I therefore re-
commended her return to Malvern, for a short course of more active
treatment. Into this I need not enter; it was as nearly as possible the
same as on the former occasion, allowance being made for the safer con-
dition of the brain, and the consequent possibility of carrying on the
treatment more fully at once. Assiduous wet-sheet packing and fomenta-
tions soon brought on the vomiting and diarrhcea crisis as before ; the
de^ifness disappeared still more suddenly than in the previous year, and in
every other particular her state has been one of health since. Constantly
taking medicine for years, she has not taken one drop or grain of any
iMt of p^e hom the tim« she came under my ctae, nearly eigfatees
10*

MS janTJscno rvLHwm ov thb BBinCy sto.

I ago. Undonbtedly, being of an excitable and anziou natino^

and of a fiimily with tendency to cerebral fulness, she will be obliged ta
nUnager her nervous system. However, she is able to vioit and reoeiva
company, she enjoys life, and is free from all chance of apoplexy ; non*
of which points she could attain under the medicinal plan of treatment
to which she had been so long subjected, but the enjoyment of which she
now owes to the water cure. It is very satisfactory to be able to add
to this ease the fc^owing letter, received from the husband of the patient
in January of the present year : —

** I am truly happy, at the commencement of the present year, to be
able to tell you that, during the space of the last eigbleen montiis, my
wife has been in the enjoyment of good health, thanks to yoitr kind and
judicious treatment by your excellent hydropathic system. She has
been seventeen years married, during which time I never knew her to be
even tolerably well, and latterly she had been getting worse and worse,
with constant pains in her head, tormenting her by day, and depriving
her of rest by night. At whatever place we visited, we were obliged to
call in medioil advice ; and I may say she had the first in and out of
London that could be obtained. Some of them attributed her complaint
to one thing, some to another ; there was no end to the applications of
leeches and blisters, and her inside was literally inundated with a vatiely
of medicines, till she was visibly about to sink under her complaint.
When I took her to Malvern, such was her distressing state, that tiiough
the distance from my home is only thirty-five miles, we were obliged to
stop a night on the road. A two months' residence at M^vem under
your care worked wonders, and now enables me to say that she has been
ever since, and still continues, perfectly well, is quite free from all pain,
and is able to eat, drink, and sleep as well as any one could desire ; and
our neighbors who knew her former state look at her with perfect asto-
nishment. From the time she first commenced your treatment to the
present, she has not had recourse to any medicines or professional assist-
ance whatever. I cannot, however, conclude this letter without expressing
to you my unbounded admiration of your.skill, and my sincere gratitude
for the very great and kind attention which you bestowed on my wife's
case ; and my earnest wish is that you may prove equally successful in
every other case that may fall under your charge."

One of the accusations against the water treatment is, that it is
apt to produce fulness of blood in the head, and apoplexy. This
is said by persons who have no experience whatsoever of it, —
who have never seen a single case of any sort treated by it. I
who have treated disease in no other way for the last three years
and a half, find a very diflferent result of large experience ; and,
were the choice given me of diseased conditions, wherein I could
(tvdace xh$ noMteartaiD and aati^actory dfeets, aad riiow fat A*

APOPLECTIC FLLNSSS OF '. BB BKAIN, 8TC.

demrest manner the safety and speedy efficacy of that-treatment,
( diould, beyond all comparison of cases, choose one of apoplectic
fulness. The patient is full of blood, has good reaction, can take
exercise, and there only remains to reduce irritation of the diges-
tive and cerebral organs, irritation, too, of the' most tractable
kind ; all these render it one of the -easiest and most satisfactory
cases to treat, and any one who knows aught of the water treat-
ment knows this.

As I have already said, pure cmgesUffii of the head is a muoh
more tedious malady to overcome than apoplectic fulness. In
fact, so tedious is it, so constaot is the necessity for watching the
ease, and, in some particular or other, changing the treatment,
adapting the kind and amount of the remedies to the varying
capabilities of the patient, that to give cases of its treatment in
written form would he all but impossible. The temperature of
the day, the state of the barometer, the quarter of the wind, are
all circumstances which, influencing the patient's physical
powers, influence also the management of his physician. Being also
a condition which is very gradually established, it is of a very
chronic character when fully formed ; and its treatment is mea-
sured by months, and sometimes by years, so intractable is it in its
greatest degree. It is, unhappily, far too common a complaint in
this countrynot to have been often presented for treatment at Mal-
vern : but, to speak truthfully, out of sixteen instances of it,
which have been under my care, I cannot vouch for perfect cure
in more than one fourth of them ; of the others, five were able
t© remain here long enough to obtain considerable benefit, but no
longer ; three only could remain, and were sanguine enough to
expect restoration in three or four weeks ; whilst in the other
cases I found the organic energy of the digestive as well as the
cerebral blood-vessels too much exhausted for even amelioration,
and very soon gave them up. Still, connected as congestion of
the brain is with old-standing irritation of the viscera, I look
upon the careful application of the water plan as the 4mo8t effi-
cient that can be employed, from its great characteristic of
saving the viscera. For a like reason, negative remedies are
indispensable ; rigorous, though not necessarily low, diet is of
very great importance, and abstinence from mental labor and
excitement not less so ; — conditions which many are not able to
fulfil through the necessary length of the treatment. Without,
l^wever, a resolution to deal fairly by the g te i n ao h y and to giv«

80A P4X8T.

the brain all possible rest, the weariec blood-vessels of
can be restored, be the water cure ever so skilfully administered :
let no one, then, attempt the latter, unless he is prepared honestly
to aid it by the former. As regards the water cure in this dis-
eased state, it has been already intimated, that its tonic appli-
ances are those principally demanded, with certain modifications,
under circumstances that are mentioned a few pages back.
* Either of the states now passed in review may terminate in
FALSY. If this ensue u^n an apoplectic seizure, it comes sud-
denly, the patient, with returning consciousness, discovering the
la<» of power in one or more limbs, or sets of voluntary muscles.
As a result of congestion o£ the brain, palsy oomes on more or
less slowly ; and in either case it is to be understood that, to be
curable, the disease must be the consequence of disordered circu.
lation alone in the brain, not of previous destructive inflammation
and softening of its substance, — that comes under the category of
organic, incurable malady.

Palsy invades the moving or the sentient nerves, or both — most
generally both ; next in frequency the power of motion is lost j
and lastly, that of sensation. Apoplectic fulness generally abo-
iishcs both motion and sensation ; congestive fulness frequently
leaves sensation untouched. The probabilities of cure depend on
its origin from either of these states, on its sudden •# slow en-
croachment, on the age and previous life of the patient, his present
organic power, &;c. A sudden attack occurring at an age under
fifty years, in a person who had not been guilty of venereal ex-
cesses or spirit drinking, and not undergone mercurial or iodine
courses, and invading one side of the body or one limb, may be
taken in hand with a pretty sure prospect of recovery by the
water cure, provided the disease bad not existed longer than four
or five years. In the opposite direction, the probabilities of course
diminish. Yet I have at this time under my care, a gentleman
of forty years of age, who, ten years ago, was seized with sudden
palsy of the whole right side, but who is slowly recovering the •
use of the arm under the operation of the water cure, which he
has pursued steadily for two years, with occasional absences from
Malvern, and relaxation, not suspension, of the treatment. I hava
little doubt that he will recover the use of the arm altogether,
though I have no such confidence regarding the leg. Rarely,
however|,does a chanca exist of even heilervng a paralysis of so .

YALsr. 901

long fltandlng : neither are the pluck and perseverance of thii
patient often fbund.

The Treatment of Palsy will be regulated in great measure
by its connection with the apoplectic or congestive fulness of the
brain, and by its duration. In cases of long standing (and all
beyond a year may be so called), and arising from congestion,
all the stimulating applications are advisable — the douche, long
shallow and sitz baths, foot baths, occasional sweatings, with the
plunge bath, or douche aller them, wet and dry frictions of the
limbs, large dooes of water, &;c. If the patient has any degree
of feverish action of the viscera, that must be first subdued by
fomenting, wet-sheet packing, &c., or, at least, remedies against
it must coalesce with those above named. If there be the signs
of apoplectic fulness, the depleting plan recommended under that
head will release the palsied parts the most readily, to which
should be added, prolonged frictions of those parts. But in this
palsy violent exertion of the limbs is not desirable, as it draws
blood towards the origin of the palsied nerves, where too much is
already collected: this is still more the case when the disease is
recent.

I give a case of palsy which I cured, premising that it is very
rarely that the malady is brought under the operation of water
treatment fit so early a date, and therefore not so likely to be
speedily cured, j)eople being generally taught and inclined to try
everything else, before they have recourse to that " dangerous"
treatmentl This patient's poverty made him unable to cherish a
prejudice, and he " rushed in" where those with fuller purses
and fatter heads " feared to tread."

Case XXIIL — ^Palst of the Right Leg.

A poor man, in his fifty-fourth year, had lost the use of his right leg
rapidly, yet not in consequence of any apoplectic seizure. From the
date of his first feding some numbness of the limb, to that of its total
loss, both of movement and sensation, not more than ten days intervened.
He came to me when the paralysis had existed between seven and eight
months. He had tendency to fulness of head by descent: he had
worked at a sedentary business, drank ale freely, but was not given to
intoxication : he had used hot condiments to a great extent, and salted
meat ; bacon formed a great part of his diet. Here, then, were causes
enough to beget and maintain an inflammatory condition of the diges* -
tive organs: and this, with constipated bowels, sufficed to fill ahead
•ongenitally prone to it. In &ct, he bad all tb6 signs of intense iiTita*

tion of the stomach, especially of its nerves : fiery red, paitiany fttrMdJ-
and swollen tongue, red eye-lids, hof and red throat, tiurst, Sic.: faotdv
large, and frequent pulse : occasional bad headache : sleep distathed and
dreamy. .All the symptoms, in short, indicated that the stomach irrita^
tion had filled the blood-vessels of the brain and spinal cord ; that in
some portion of that apparatus these overloaded vessels had pressed
upon the nervous matter, and prevented the message of sensation and
movement thence to the leg. Further, as the attack had not come on
with apoplectic s«Hzure, yet neither had come on slowly, it might he pre-
dicated that some congestive fulness existed, although Ihe greater part of
the blood-vessels were in the state of i^wpleetic distension ; and ^e con-
coinitant signs showed this combination.

The treatment, therefore, was evident After two days of preliminaiy
wet-sheet rubbing, I had him packed in a wet sheet for an hour, with a
shallow bath at 60o, with cold effusion on the head, and considerable
friction of the whole body. Ite wore a compress on the abdomen, and
drank four tumblers of water daily. This was all his treatment for
nearly a fortnight. ' But, meantime, I had reduced his diet to vegetable
materials, except on two days of the week. Wet and dry friction of the
afifected limb was employed twice a-day for a quarter of an hour. AU
this materially reduced the symptoms of internal irritation, and improved
his sleep : it also began to act beneficially on the bowels. I had avoided
more active treatment at tlie. outset, in order that the tendency of the
blood-vessels of the brain to pass to the congestive state, might be ob-
viated. Now, however, that the irritations coming from the stomach
were reduced, I ventured to carry out the depletory process more fuUy,
and the patient was fomented at night for an hour, was packed in the
wet sheet each morning, and had a sitz bath at 60® of three quarters of
an hour at noon. Another fortnight of this brought him to two wet*
sheet packings in the day, and a long sitz bath. A good amount of
general exercise was taken, and the diseased leg was exercised artifi-
cially by considerable frictions with hard towels. The treatment pulled
him down a good deal in appearamie, but Ills sensations were those of
vastly increased comfort of head. The pulse fell, the tongue and throat
paled, and ail the signs of decreased irritation were present. As yet,
this is, nine weeks after the commencement of treatment, the only fresh
signs in the palsied leg were occasional ach'ings. Regarding these as
efibrts of nature to re-establish the function of the nerves of the limb,
now that the internal cause had been reduced, I followed them up by
curtailing the amount of wet^sheet packing, and substituting a short
douche of half a minute daily, received on the loins and on the palsied
leg. More water was drunk : the shallow bath was lengthened to five or
six minutes : the sitz reduced to a quarter of an hour : and both were
administered cold. The diet was the same, only a little more latitude
was given as to quantity. He continued this for" nearly three weeks,
tiio douche being meaawbile gradually exts&dod to two and thm '

^ALSY. 207

Tbo leg ftdvuced in power of novement, but sensadoii
lagged much more. I now gave up the wet-eheet packing altogether,
and adhered to the tonic remedies only^ under which the patient got on
even rapidly, for, in the sixteenth week of treatment, he was able to halt
a short distance without any kind of support. He continued to use the
douche, the cold shallow and sitz baths, frictions, water drinking, to the
amount of seven and eight tumblers daily, exercise, and diet of ani-
mal food three times a week, for a fortnight longer, when he wishing to, .
and I judging that he might, return home, he left Malvern cured of his
palsy, though he still walked somewhat lame. This is invariably the
case when palsy has existed more than a few weeks, and Is in great
part owing to the long disuse of the muscles : the accurate command over
them, thiDQgh the nerves, is slowly recovered : the limb, in short, has to
be educated. In the present instance, it took a month to gain complete
and precise use of the limb^ after he had ceased active treatment.

This will give an idea of the process of cure in an ordinary
case of palsy. As I have said, the process is generally a much
longer one, because the palsy has usually existed a much longer
time. On the other hand, I have had a case here wherein the
palsy had followed a slight apoplectic seizure only a fortnight be-
fore, and had possession of one half the body : here the whole
paralyzed parts were restored by three weeks of wet-sheet pack-
ing, the shallow bath, and two or three foot baths daily, and
appropriate diet* In such instances, the only mischief to remove
is, the excessive irritation of the viscera, which has caused con-
gestive circulation in the brain and spinal cord : this last has not
had time to become fixed, nor the entire system accustomed to its
presence, and it therefore readily disappears with the disappear-
ance of its cause in the viscera. Similar to this is the hysterical
palsy. In it there is no general. fulness of blood, but a highly
irritative istate of the womb and its appendages, and more or less
of the stomach too, which oppresses the function most frequently
of the lower part, but sometimes of the upper too, of the spinal
cord. Such suspension or palsy oflen takes place suddenly, and is
as suddenly removed, each time without any apparent cause ; but
it also occasionally remains for weeks or months. A high degree
of nervousness accompanies this kind of palsy, which, in fact, is
only liable to occur in women who are congenitally of very deli-
cate and highly sensitive nature. One case of paralysis of the
left arm, which had existed for several weeks, I cured in twelve
day9> with fomentations, wet-sheet packing, and the long sits bath«^
la.mBother jci^, where the palsy had come and gone freijaentiy *

IM APOFLBCTIC FULNESS OF THE BBAIN, 8T0.

fiir Congestion of the head. The patient accordingly took a
shower bath daily, more and stronger food, less exercise, and
very little water, adding to those the genial tonic of change of
scene and circumstance. Having a good constitution to go upon,
this succeeded, although it took a long time. Had he been
guided by me from the beginning, seen me oflener, and had his
symptoms closely attended to, and his treatment modified accord,
log to them, he would have reached the point of health he now
possesses without the peril and disagreeables he passed through.
But whilst this case shows the danger of using the water treat-
ment without advice and discretion, it also exhibits the very great
power it includes of permanently reducing a condition of brain,
which all other modes of treatment only relieve for a brief period,
and which in this case had not been relieved, even for a short
time, by any of them.

Case XXIL — ^Afoflectic and Conoesitve Fulness of the Head—
Deafkess — ^Intense Headache.

For several yeaj-s, a lady, of forty-eight years of age, had been subject
to most distressing and alarming head symptoms ; intense, prostrating
headaches ; giddiness that caused her to reel ; bursting sensation of the
skull ; violent and irritating noises constantly in the head. To these
were added, great nervousness, bound bowels, scanty urine, constant fe-
verishness, vehement flushings of the face, ice-cold feet. The pulse was
large, bat yielding and most irregular ; appetite small ; sleep very much
disturbed. She had undergone violent medication at the hands of the
first metropolitan and provincial authorities, whose object appears to
have been to derive powerfully from the head, by such remedies as five
grains of calomel at night, with some drastic draught in the morning ;
whilst little attention seems to have been given to the diet. However,
between the original malady and the excessive irritation set up by the
medicinal treatment, the nerves, both ganglionic and cerebral, and their
centres, were in the most alarming condition.

All the symptoms evidenced that middle state of the cerebral blood-
vessels which I have mentioned as the transition from the active^ fulness
of appplectic to the totally passive fulness of congestive disorder, and to
the difficulty of treating which I have alluded. Accordingly, I com-
ipenced the treatment very carefully. The details are as follows : —

August 1st. — Hot fomentations to the abdomen for an hour at bed-
time ; the flannels changed every ten minutes, and a wine-glass of cold
water drank, at each change. Damp compress on the bowels, to be
worn night and day. From three to four tumblers of cold water daring

jmPLBCTIC FDLNBS6 OF TB& BLAIN, BTCL IW

Iba 4ay, to be taJsen in small quantities at a time. -Bieakfiiat <A eM
toast «ii a. little butter ; no liquid whatever. For dinner, three ouncaf
of animal food — ^mutton, beef, poultry, and game, three times a week,
with as little liquid as possible. On other days, the dinner to consist of
a cup of cocoa, with cold toast and butter ; or of some farinaceous
pudding, eaten nearly cold. Very weak and almost cold black tea in
the evening, with cold toast and butter. The pulse becoming less haid
and bounding under this, I proceeded with more decided treatment

4tb.~^Packed in wet sheet for an hour bejfore break£urt Dripping
sheet after it. All the rest as before.

6th. — The same, except that the shallow bath was used instead of the
rubbing sheet after the packing. The patient remained four minutes in
it, was well rubbed, and had water repeatedly poured over the head.

9th. — Sitz bath at 70^, for a quarter of an hour at noon, was added to
the above. Did not agree ; headache came an hour or two after it

12th. — ^Packing and shallow bath before break&st ; a foot bath of cold
water, with some mustard flour in it, for ten minutes twice in the day ;
fomentations at night ; abdominal compress ; three to four tumblers of
water. This was the treatment up to the

27th. — The head suffering a good deal, ordered foot bath of mustard
and water ; also that the nape of the neck should be rubbed for fifteen
minutes with the same mixture. Head immediately relieved. This in-
stead of the packing.

28th. Packing as usual. Three foot baths in the courae of the day.

September 2d. — ^Pulse considerably reduced by the long-continued
packing, fomentations, &c. ; somewhat incUned to hysteria, too. Ner^
vous headache. All these signs indicated that the lowering process had,
for the present, been carried as far, or at least as &st, as the system
could bear. Therefore, on the

dd.-— -I only ordered the cold shallow bath before tereakfiist, with Hm
foot baths as usual.

4th. — Shallow bath on rising ; foot baths as usual ; sitz bath at noon
for half ui hour. Rode out in a wheel-chair at two o'clock for an hour ;
came home and vomited copiously until five o'clock. Here was the* be-
ginning of an irUemal crisis, which the packing, fomentations, &c., by
removing the irritative state of the internal organs, had enabled them to
efiect The nervous condition of the 2d, was the symptom of the com-
mencing effort which terminated in this manner. The matter vomited
consisted of a large quantity of clear, frothy mucus, mixed with an equal
quantity of a black, tenacious, and heavy substance. A cold sitz bath
for ^ quarter of an hour after it, and fomentations at night, removed all
traces of the emetic tumult.

5th .^-Shallow bath in the morning ; foot and hand baths three times
in tlie day ; sitz bath for half an hour at noon, and a quarter of an
.h(m jftt five P.M. Discharge of blood from the bowels in the monuag^

too APOPLECTIC FULNESS OF THE BBAIlf, .STO.

^-another character of the internal crisis. Head altogether free from
pain ; and she said she felt lighter and better than she had ever done.

6th. — ^Treatment as above. Fomentations at bed-time ; walked more
than half a mile steadily ; much better to-day. In the coarse of the
night colicky pains, followed by free diarrhoea, the bowels acting twice.

7th. — Treatment the same. Walked ; and then drove out for an hour.
Felt better than she had done from the beginning.

8th. — Nothing but shallow bath. But as she became languid from
going to church, she took a foot bath, which soon restored her. Quite
well in all other respects.

10th. — Some little feverish disturbance induced me to order a packing
to-day. Foot, hand, and sitz baths as before. Head became bad from
too long a drive. Fomentations at bed-time.

nth. — After a good night felt well; ordered foot baths. Suddenly
seized with copious vomiting and purging. Took sitz bath after them
and went out, quite well.

13th. — ^Walked out twice, and drove once. Packed in the morning
m wet sheet. Two sitz and two foot baths, and several hand baths in
the day. A considerable quantity of blood passed from the bowels.

15th. — Sick again.

19th. — Head for the last week perfectly well, and admitting of a good
amount of exercise. This day, however, she overdid it, and the head
became bad in the night. Had not packed for three days, but, on ac-
count of the increased headache, she on the

20th, — ^Packed ; did not walk out at all ; took one foot and one sitz
bath, and a drive.

From this time to the 24th, when this patient left Malvern, she conti-
nued to take the shallow bath in the morning, two foot baths, and two
hand baths. Throughout the latter month of the treatment, the vomit-
ing and purging, with occasional discharge of blood from the bowels,
continued in varied degree ; but I have only noted the days when either
of these was excessive. Fomentations were frequently employed at
night for twenty or thirty minutes, acconiing to the transitory condition
of the head ; when it was worse, with increased strength of pulse, they
were used ; when it was bad, without that sign, additional foot baths and
sitz baths were beneficially taken.

This lady left Malvern on the 24th September, taking with her the
following directions to be pursued at home : —

" Shallow bath at 68** every morning for two minutes.

Two foot baths of ten minutes each in the course of the day.

A sitz bath at 65^ for half an hour every other day at noon, or any
time three hours after a meal.

Wear the compress all day.

It would be well to pack in the wet sheet once a week or so, with the
■baUow bath as above ; but if allis right in the head and 1x>wel»— thil

APOFLBCTIC FULNESS OP THE BRAINy ETC. 801

isyif the head is free from heat and pain, and the bowels sufficiently ope«
—omit this.

' Vegetable diet, except three times a week, when animal food may be
taken at dinner.*'

The deafness with which the patient was afl^ted varied in the course
of her treatment at Malvern, but, on the whole, diminished so much that,
by the time she left, she could hear perfectly well, if too many voices
were not crossing each other at once. Perseverance in the above direc-
tions at home completely restored it.

It should be recalled that, previously to trying the water treatment, this
lady, whose positfon in society is high, had been rendered incapable of
entering it ; the excitement of the smallest riunion was too much for her
head ; besides which, the headaches were so frequent and so intense, that
she could form no engagement with the smallest certainty of being able
to fulfil it ; withal, her increasing deafness was daily rendering society
impossible and distasteful to her. Neither could she find pleasure in
travelling ; for ten or twelve miles, in the easiest carriage, was more than
she could bear in one day. But after going through the above treatment,
all this was changed. Her headaches had gone — ^gone so far, that be-
tween September, 1844, when she left Malvern, and May, 1845, when
she returned, she had not more than three attacks for a few hours (in-
duced by mental excitement), and of a vastly mitigated character, instead
of one or two bad attacks every week, and more or less of it every day.
The restoration of her hearing was her restoration to society. And the
certainty she had that, at any time when the head had been tired by talk-
ing and listening, she could put herself to rights with a wet sheet and a
foot bath, rendered the life worth possessing which had been for a long
time previously intolerable. In this altered state of circumstances she
passed through the winter of 1844-46. In the month of May of the last
year, a considerable amount of mental excitement, experienced whilst
undergoing the physical excitement of travelling from place to place,
added to irregularities of times of eating inseparable therefrom, brought
back some of her ailments ; that is to say, some degree of flushing, and
a considerable degree of deafness ; in all other respects she remained
well, showing the partial character of the mischief. Still, the causes
had been re-applied, and the effects were inevitable ; and I therefore re-
commended her return to Malvern, for a short course of more active
treatment. Into this I need not enter; it was as nearly as possible the
same as on the former occasion, allowance being made for the safer con-
dition of the brain, and the consequent possibility of carrying on the
treatment more fully at once. Assiduous wet-sheet packing and fomenta-
tions soon brought on the vomiting and diarrhcea crisis as before ; the
deafness disappeared still more suddenly than in the previous year, and in
every other particular her state has been one of health since. Constantly
taking medicine for years, she has not taken one drop or grain of any
iMt of pbysic Iran the tims she eame under my esie, nsarly ei^lrtusn
10*

Ml AfOYLBCTIC F9LNX88 09 THB BHJLIMy EfO*

flMJoHiBJigo. Undonbtedly, being of tn excitable and awdou mban-

and of a &mily with tendency to cerebral fulness, she will be obliged ta
mhkoger her n^vous system. However, she is able to visit and leoeiva
company, she enjoys life, and is free from all chance of apoplexy ; noiM
of which points she conld attain under the medicinal plan of treatment
to which she had been so long subjected, but the enjoyment of which she
now owes to the water cure. It is very satisfactory to be able to add
to this ease the following letter, received from the husband of the patient
in January of the present year : —

*' I am truly happy, at the commencement of the present year, to be
able to tell you that, during the space of the last eigfaleen months, my
wife has been in the enjoyment of good health, thanks to yov kind and
judicious treatment by your excellent hydropathic system. She has
been seventeen years married, during whidi time I never knew her to be
even tolerably well, and latterly she had been getting worse and worse,
with constant pains in her head, tormenting her by day, and depriving
her of rest by night At whatever place we visited, we were obliged to
call in medi(»l advice ; and I may say she had the first in and out of
London that could be obtained. Some of them attributed her complaint
to one thing, some to another ; there was no end to the applications of
leeches and blisters, and her inside was literally inundated with a variety
of medicines, till she was visibly about to sink under her complaint
When I took her to Malvern, such was her distressing state, that tiiongh
the distance from my home is only thirty-five miles, we were obliged to
stop a night on the road. A two months' residence at M^vem under
your care worked wonders, and now enables me to say that she has been
ever since, and still continues, perfectly weU, is quite free from aU pain,
and is able to eat, drink, and sleep as well as any one could desire ; and
our neighbors who knew her former state look at her with perfect asto-
nishment. From the time she first commenced your treatment to the
present, she has not had recourse to any medicines or professional assist-
ance whatever. I cannot, however, conclude this letter without expressing
to you my unbounded admiration of your.skil], and my sincere gratitude
for the very great and kind attention which you bestowed on my wife's
case ; and my earnest wish is that you may prove equally successful in
every other case that nuiy fall under your charge."

One of the accusations against the water treatment is, that it is
apt to produce fulness of blood in the head, and apoplexy. This
is said by persons who have no experience whatsoever of it, —
who have never seen a single case of any sort treated by it. I
who have treated disease in no other way for the last three yeara
and a half, find a very different result of large experience ; and,
were the choice given me of diseased conditions, wherein I could
pradiice Xh» mofltceHtin Mid ««U^actory ^eet», and ^how fat tte

AFOPLBCTIC FtLNBSS Of *. HB BRAIM) JNO.

olearost manner the safety and speedy efficacy of that.treatmenty
( should, heyond all comparison of cases, choose one of apoplectio
fulness. The patient is full of blood, has good reaction, can take
exercise, and there only remains to reduce irritation of the diges-
tive and cerebral organs, irritation, too, of the' most tractable
kind ; all these render it one of the easiest and most satisfactory
cases to treat, and any one who knows aught of the water treat,
ment knows this.

As I have already said, pure efrngesUffii ofihe head is a much
more tedious malady to overcome than apoplectio fulness. In
fact, so tedious is it, so constant is the necessity for watching the
ease, and, in some particular or other, changing the treatment,
adapting the kind and amount of the remedies to the varying
capabilities of the patient, that to give cases of its treatment in
written form would he all but impossible. The temperature of
the day, the state of the barometer, the quarter of the wind, are
all circumstances which, influencing the patient's physical
powers, influence also the management of his physician. Being also
a condition which is very gradually established, it is of a very
chronic character when fully formed ; and its treatment is mea-
sured by months, and sometimes by years, so intractable is it in its
greatest degree. It is, unhappily, far too common a complaint in
this countrf^'not to have been often presented for treatment at Mai-
vem : but, to speak truthfully, out of sixteen instances of it,
which have been under my care, I cannot vouch for perfect cure
in more than one fourth of them ; of the others, five were able
to remain here long enough to obtain considerable benefit, but no
longer ; three only could remain, and were sanguine enough to
expect restoration in three or four weeks ; whilst in the other
cases I found the organic energy of the digestive as well as the
cerebral blood-vessels too much exhausted for even amelioration,
and very soon gave them up. Still, connected as congestion of
the brain is with old-standing irritation of the viscera, I look
upon the careful application of the water plan as the jnost effi-
cient that can be employed, from its great characteristic of
saving the viscera. For a like reason, negative remedies are
indispensable ; rigorous, though not necessarily low, diet is of
very great importance, and abstinence from mental labor and
excitement not less so ; — conditions which many are not able to
fulfil through the necessary length of the treatment. Without,
l^WQver, a retolution to deal fairly by the stomaeh, and to givo

204 PiXST.

the brain all possible rest, the weariec blood-vessels of neitte
can be restored, be the water cure ever so skilfully administered :
let no one, then, attempt the latter, unless he is prepared honestly
to aid it by the former. As regards the water cure in this dis.
eased state, it has been already intimated, that its tonic appli.
ances are those principally demanded, with certain modifications,
under circumstances that are mentioned a few pages back.
* Either of the states now passed in review may terminate in
PALSY. If this ensue u^n an apoplectic seizure, it comes sud-
denly, the patient, with returning consciousness, discovering the
\osiSi of power in one or more limbs, or sets of voluntary muscles.
As a result of congestion of the brain, palsy comes on more or
less slowly ; and in either case it is to be understood that, to be
curable, the disease must be the consequence of disordered circu-
lation alone in the brain, not of previous destructive inflammation
and softening of its substance, — thcU comes under the category of
organic, incurable malady.

Palsy invades the moving or the sentient nerves, or both — most
generally both ; next in frequency the power of motion is lost ;
and lastly, that of sensation. Apoplectic fulness generally abo-
lishes both motion and sensation ; congestme fubness frequently
leaves sensation untouched. The probabilities of cure depend on
its origin from either of these states, on its sudden ^ slow en-
croachment, on the age and previous life of the patient, his present
organic power, &c. A sudden attack occurring at an age under
fifty years, in a person who had not been guilty of venereal ex-
cesses or spirit drinking, and not undergone mercurial or iodine
courses, and invading one side of the body or one limb, may be .
taken in hand with a pretty sure prospect of recovery by the
water cure, provided the disease had not existed longer than four
or five years. In the opposite direction, the probabilities of course
diminish. Yet I have at this time under my care, a gentleman
of forty years of age, who, ten years ago, was seized with sudden
palsy of the whole right side, but who is slowly recovering the
use of the arm under the operation of the water cure, which he
has pursued steadily for two years, with occasional absences from
Malvern, and relaxation, not suspension, of the treatment. I have
little doubt that he will recover the use of the arm altogether,
though I have no such confidence regarding the leg. Rarely,
however|.does a chanca exist of even hetiering a paralysis of so .

lALST. 9fM

long standing : neither are the pluck and perseverance of thii
patient often found.

The Treatment of Palsy will be regulated in great measure
by its connection with the apoplectic or congestive fulness of the
brain, and by its duration. In cases of long standing (and all
beyond a year noay be so called), and arising from congestion,
all the stimulating applications are advisable — ^the douche, long
shallow and sitz baths, foot baths, occasional sweatings, with the
plunge bath, or douche after them, wet and dry frictions of the
limbs, lai^ doses of water, &c. If the patient has any degree
of feverish action of the viscera, that must be first subdued by
fomenting, wet-sheet packing, &;c., or, at least, remedies against
it must coalesce with those above named. If there be the signs
of apoplectic fulness, the depleting plan recommended under that
head will release the palsied parts the most readily, to which
should be added, prolonged frictions of those parts. But in this
palsy violent exertion of the limbs is not desirable, as it draws
blood towards the origin of the palsied nerves, where too much is
already collected : this is still more the case when the disease is
recent.

I give a case of palsy which I cured, premising that it is very
rarely that the malady is brought under the operation of water
treatment 4tt so early a date, and therefore not so likely to be
speedily cured, people being generally taught and inclined to try
everything else, before they have recourse to that " dangerous'*
treatment^ This patient's poverty made him unable to cherish a
prejudice, and he " rushed in" where those with fuller purses
and fatter heads << feared to tread."

Case XXIIL — ^Palst or the Right Leg.

A poor man, in his fifty-fourth year, had lost the use of his right leg
rapidly, yet not in consequence of any apoplectic seizure. From the
date of his first feeing some numbness of the limb, to that of its total
loss, both of movement and sensation, not more than ten days intervened.
He came to me when the paralysis had existed between seven and eight
months. He had tendency to fulness of head by descent: he had
worked at a sedentary business, drank ale freely, but was not given to
intoxication : he had used hot condiments to a great extent, and salted
meat ; bacon formed a great part of his diet. Here, then, were causes
enough to beget and maintain an inflammatory condition of the diges-
tive organs : and this, with constipated bowels, sufficed to fill a head
wngenitaUy prone to it In £ftct, he had* all the signs of inisnse iiTit»*

tion of the stomach, especially of its nerves: fiery red, paitiany ftuts^
and swollen tongue, red eye-lids, hof and red throat, tiiirst, die.: faotd;
large, a^d frequent pulse : occasional bad headache : sleep distaibed and
dreamy. .All the symptoms, in short, indicated that the stomach irrit»«
tion had filled the blood-vessels of the brain and spinal cord ; that in
some portion of that apparatus these overloaded vessels had pressed
upon the nervous matter, and prevented the message of sensation and
movement thence to the leg. Further, as the attack had not come on
with apoplectic seizure, yet neither had come on slowly, it might he pre-
dicated that some congestive fulness existed, although Ihe greater part of
the blood-vessels were in the state of a{K>plectic distension ; and the con-
comitant signs showed this combination.

The treatment, therefore, was evident After two days (tf preUminaiy
wet-sheet rubbing, I had him packed in a wet sheet for an hour, with a
shallow bath at 60o, with cold efiusion on the head, and considerable
friction of the whole body. Ite wore a compress on the abdomen, and
drank four tumblers of water daily. This was all his treatment for
nearly a fortnight. But, meantime, I had reduced his diet to vegetable
materials, except on two days of the week. Wet and dry friction of the
affected limb was employed twice a-day for a quarter of an hour. All
this materially reduced the symptoms of internal irritation, and improved
his sleep : it also began to act beneficially on the bowels. I had avoided
more active treatment at the. outset, in order that the tendency of the
blood-vessels of the brain to pass to the congestive state, might be ob-
viated. Now, however, that the irritations coming from the stomach
were reduced, I ventured to carry out the depletory process more fully, *
and the patient was fomented at night for an hour, was packed in the
wet sheet each morning, and had a sitz bath at 60^ of three quarters of
an hour at noon. Another fortnight of this brought him to two wet-
sheet packings in the day, and a long sitz bath. A good amount of
general exercise was taken, and the diseased leg was exercised artifi-
cially by considerable frictions with hard towels. The treatment pulled
him down a good deal in appear ande^ but his sensations were those of
vastly increased comfort of head. The pulse fell, the tongue and throat
paled, and all the signs of decreased irritation were present. As yet,
this is, nine weeks after the commencement of treatment, the only fresh
signs in the palsied leg were occasional acHings. Regarding these as
eflbrts of nature to re-establish the function of the nerves of the limb,
now that the internal cause had been reduced, I followed them up by
curtailing the amount of wet-sheet packing, and substituting a short
douche of half a minute daily, received on the loins and on the palsied
leg. More water was drunk : the shallow bath was lengthened to five or
six minutes : the sitz reduced to a quarter of an hour : and both were
administered cold. The diet was the same, only a little more latitude
was given as to quantity. He continued this for nearly three weeks,
tiio douche being meaawbile gradually exts&ded to two and thM9 *

^ALSV. 207

mlimtet. l%e leg ftdvuced in power of novement, but sensalioii
lagged much more. I now gave up the wet-sheet packing altogether,
and adhered to the tonic remedies only, under which the patient got on
even rapidly, for, in the sixteenth week of treatment, he was able to halt
a short distance without any kind of support. He continued to use the
douche, the cold shallow and sitz baths, irictions, water drinking, to the
amount of seven and eight tumblers daily, exercise, and diet of ani«
mal food three times a week, for a fortnight longer, when he wishing to, .
and I judging that he might, return home, he left Malvern cured of his
palsy, though he still walked somewhat lame. This is invariably the
case when palsy has existed metre than a few weeks, and is in great
part owing to the long disuse of the muscles : the accurate command over
them, through the nerves, is slowly recovered : the limb, in short, has to
be educated. In the present instance, it took a month to gain complete
and precise use of the limb, after he had ceased active treatment.

This will give an idea of the process of cure in an ordinary
case of palsy. As I have said, the process is generally a much
longer one, because the palsy has usually existed a much longer
time. On the other hand, I have had a case here wherein the
palsy had followed a slight apoplectic seizure only a fortnight be-
fore, and had possession of one half the body : here the whole
paralyzed parts were restored by three weeks of wet-sheet pack-
ing, the shallow bath, and two or three foot baths daily, and
appropriate diet. In such instances, the only mischief to remove
is, the excessive irritation of the viscera, which has caused con-
gestive circulation in the brain and spinal cord : this last has not
had time to become fixed, nor the entire system accustomed to its
presence, and it therefore readily disappears with the disappear-
ance of its cause in the viscera. Similar to this is the hysterical
palsy. In it there is no general. fulness of blood, but a highly
irritative istate of the womb and its appendages, and more or less
of the stomach too, which oppresses the function most frequently
of the lower part, but sometimes of the upper too, of the spinal
cord. Such suspension or palsy often takes place suddenly, and is
as suddenly removed, each time without any apparent cause ; but
it also occasionally remains for weeks or months. A high degree
of nervousness accompanies this kind of palsy, which, in fact, is
only liable to occur in women who are congenitally of very deli-
cate and highly sensitive nature. One case of paralysis of the
left arm, which had existed for several weeks, I cured in twelve
days> with fomentations, wet-sheet packing, and the long sits bath^
In. another .c^se^ where the palsy had come and gone freijoetitly *

IM APOPLECTIC FULNESS OF THE BBAIN, ETC.

ftr Congestion of the head. The patient accordingly took a
shower bath daily, more and stronger food, less exercise, and
very little water, adding to those the genial tonic of change of
scene and circumstance. Having a good constitution to go upon,
this succeeded, although it took a long time. Had he been
guided by me from the beginning, seen me oflener, and had his
symptoms closely attended to, and his treatment nKxlified accord-
ing to them, he would have reached the point of health he now
possesses without the peril and disagreeables he passed through.
But whilst this case shows the danger of using the water treat-
ment without advice and discretion, it also exhibits the very great
power it includes of permanently reducing a condition of brain,
which all other modes of treatment only relieve for a brief period,
and which in this case had not been relieved, even for a short
time, by any of them.

Case XXIL — ^Apoplectio and Congestive Fulness or the Head—
Deafness — Intense Headache.

For several years, a lady, of forty-eight years of age, had been subject
to most distressing and alarming head symptoms ; intense, prostrating
headaches ; giddiness that caused her to reel ; bursting sensation of the
skul] ; violent and irritating noises constantly in the head. To these
were added, great nervousness, bound bowels, scanty urine, constant fe-
verishness, vehement flushings of the fiice, ice-cold feet. The pulse was
lasge, but yielding and most irregular ; appetite small ; sleep very much
disturbed. She had undergone violent medication at the hands of the
first metropc^itan and provincial authorities, whose object appears to
have been to derive powerfully from the head, by such remedies as five
grains of calomel at night, with some drastic draught in the morning ;
whilst little attention seems to have been given to the diet. However,
between the original malady and the excessive irritation set up by the
medicinal treatment, the nerves, both ganglionic and cerebral, and their
centres, were in the most alarming condition.

All the symptoms evidenced that middle state of the cerebral blood-
vessels which I have mentioned as the transition from the active^ fulness
of apoplectic to the totally passive fulness of congestive disorder, and to
the difficulty of treating which I have alluded. Accordingly, I com-
menced the treatment very carefully. The details are as follows : —

August 1st. — Hot fomentations to the abdomen for an hour at bed-
time ; the flannels changed every ten minutes, and a wine-glass of cold
water drank. at each change. Damp compress on the bowels, to be
worn night and day. From three to four tumblers of cold water daring

4.V0PLXCTIC FULNESS OF TH& B&AIN, BTCL IW

Ibailay, to be taken in small quantities at a time. -Break&at of eoU
toast mi a little butter ; no liquid whatever. For dinner, three oonce*
of animal food — mutton, beef, pioultry, and game, three times a week,
with as little liquid as possible. On other days, the dinner to consist of
a cup of cocoa, with cold toast and butter ; or of some fiirinaceons
pudding, eaten nearly cold. Very weak and almost cold black tea in
the evening, with cold toast and butter. The pulse becoming less haid
and bounding under this, I proceeded with more decided treatment

4th. — ^Packed in wet sheet for an hour before breakfiurt Drilling
sheet after it. All the rest as before.

5th.^-The same, except that the shallow bath was used instead of the
rubbing sheet after the packing. The patient remained four minutes in
it, was well rubbed, and had water repeatedly poured over the head.

9th. — Sitz bath at 70^, for a quarter of an hour at noon, was added to
the above. Did not agree ; headache came an hotu* or two after it

12th. — ^Packing and shallow bath before break&st ; a foot bath of cold
water, with some mustard flour in it, for ten mmutes twice in the day ;
fomentations at night ; abdominal compress ; three to four tumblers of
water. This was the treatment up to the

27th. — ^The head suffering a good deal, ordered foot bath of mustard
and water ; also that the nape of the neck should be rubbed for fifteen
minutes with the same mixture. Head immediately relieved. This in-
stead of the packing.

28th. Packing as usual. Three foot baths in the course of the day.

September 2d. — Pulse considerably reduced by the long-continued
packing, fomentations, &c. ; somewhat incUned to hysteria, too. Nei^
vous headache. All these signs indicated that the lowering process had,
for the present, been carried as far, or at least as fast, as the system
could bear. Therefore, on the

3d. — ^I only ordered the cold shallow bath before Inreak&st, with 11m
foot baths as usual.

4th. — Shallow bath on rising ; foot baths as usual ; sitz bath at noon
for half an hour. Rode out in a wheel-chair at two o'clock for an hour ;
came home and vomited copiously until five o'clock. Here was the* be-
ginning of an internal crisis, which the packing, fomentations, &c., by
removing the irritative state of the internal organs, had enabled them to
efiect The nervous condition of the 2d, was the symptom of the com-
mencing efK>rt which terminated in this manner. The matter vomited
consisted of a large quantity of clear, frothy mucus, mixed with an equal
quantity of a black, tenacious, and heavy substance. A cold sitz bath
for a quarter of an hour after it, and fomentations at night, removed all
traces of the emetic tumult

5th Shallow bath in the morning ; foot and hand baths three times

in the day ; sitz bath for half an hour at noon, and a quarter of aa
i^ur at five p.m. discharge of blood from the bowela in the i

too APOPLECTIC FULNESS OF THE BEAUf, .STO.

—another character of the internal crisis. Head altogether free froEt
pain ; and she said she felt lighter and better than she had ever done.

6th. — Treatment as above. Fomentations at bed-time ; walked more
than half a mile steadily ; much better to-day. In the coarse of the
night colicky pains, followed by free diarrhoea, the bowels acting twice.

7th. — Treatment the same. Walked ; and then drove out for an hour.
Felt better than she had done from the beginning.

8th. — ^Nothing but shallow bath. But as she became languid from
going to church, she took a foot bath, which soon restored her. Quite
well in all other respects.

10th. — ^Some Httle feverish disturbance induced me to order a packing
to-day. Foot, hand, and sitz baths as before. Head became bad from
too long a drive. Fomentations at bed-time.

11th. — After a good night felt well; ordered foot baths. Suddenly
seized with copious vomiting and purging. Took sitz bath after them
and went out, quite well.

13th. — ^Walked out twice, and drove once. Packed in the morning
m wet sheet. Two sitz and two foot baths, and several hand baths in
the day. A considerable quantity of blood passed from the bowels.

15th. — Sick again.

19th. — Head for the last week perfectly well, and admitting of a good
amount of exercise. This day, however, she overdid it, and the head
became bad in the night. Had not packed for three days, bat, on ac*
count of the increased headache, she on the

20th, — ^Packed ; did not walk out at all ; took one foot and one sitz
bath, and a drive.

From this time to the 24th, when this patient left Malvern, she conti-
nued to take the shallow bath in the morning, two foot baths, and two
hand baths. Throughout the latter month of the treatment, the vomit-
ing and purging, with occasional discharge of blood from the bowels,
continued in varied degree ; but I have only noted the days when either
of these was excessive. Fomentations were frequently employed at
night for twenty or thirty minutes, accoi^ing to the transitory condition
of the head ; when it was worse, with increased strength of poise, they
were used ; when it was bad, without that sign, additional foot baths and
sitz baths were beneficially taken.

This lady left Malvern on the 24th September, taking with her the
following directions to be pursued at home : —

" Shallow bath at 68** every morning for two minutes.

Two foot baths of ten minutes each in the course of the day.

A sitz bath at 66° for half an hour every other day at noon, or any
time three hours after a meal.

Wear the compress all day.

It would be well to pack in the wet sheet once a week or so, with th«
iMkyw bath as above ; but if all is right in the head and boweL»— >tlM|t

ATOPLBCTIC FVLNSSS OP THE BBAIN, ETC. 801

fB, if the head is free from heat and pain, and the bowels snfficioitly opei
^-omit this.

' Vegetable diet, except three times a week, when animal food may b«
taken at dinner."

The deafness with which the patient was afiected varied in the course
of her treatment at Malvern, but, on the whole, diminished so much that,
by the time she left, she could hear perfectly well, if too many voices
were not crossing each other at once. Perseverance in the above direc*
tions at home completely restored it.

It should be recalled that, previously to trying the water treatment, this
kdy, whose position in society is high, had been rendered incapable of
entering it ; the excitement of the smallest reunion was too much for her
head ; besides which, the headaches were so frequent and so intense, that
she could form no engagement with the smallest certainty of being able
to fulfil it ; withal, her increasing deafness was daily rendering society
impossible and distasteful to her. Neither could she find pleasure in
travelling ; for ten or twelve miles, in the easiest carriage, was more than
she could bear in one day. But after going through the above treatment,
all this was changed. Her headaches had gone — ^gone so far, that be-
tween September, 1844, when she left Malvern, and May, 1846, when
she returned, she had not more than three attacks for a few hours (in-
duced by mental excitement), and of a vastly mitigated character, instead
of (me or two bad attacks every week, and more or less of it every day.
The restoration of her hearing was her restoration to society. And the
certawiy she had that, at any time when the head had been tired by talk-
ing and listening, she could put herself to rights with a wet sheet and a
foot bath, rendered the life worth possessing which had been for a long
time previously intolerable. In this altered state of circumstances she
passed through the winter of 1844-45. In the month of May of the last
year, a considerable amount of mental excitement, experienced whilst
undergoing the physical excitement of travelling from place to place,
added to irregularities of times of eating inseparable therefrom, brought
back some of her ailments ; that is to say, some degree of flushing, and
a considerable degree of deafness ; in all other respects she remained
well, showing the partial character of the mischief. Still, the causes
had been re-applied, and the eflects were inevitable ; and I therefore re-
commended her return to Malvern, for a short course of more active
treatment. Into this I need not enter; it was as nearly as possible the
same as on the former occasion, allowance being made for the safer con-
dition of the brain, and the consequent possibility of carrying on the
treatment more fully at once. Assiduous wet-sheet packing and fomenta-
tfons soon brought on the vomiting and diarrhoea crisis as before ; the
deafness disappeared still more suddenly than in the previous year, and in
every other particular her state has been one of health smce. Constantly
taldng medicine for years, she has not taken one drop or grain of any
iMt of pbysic hmt the time she came under my care, Hearty eigfadees
10*

219 6SNEBAL GANGLIONIC ISRITATIOM.

the digestive and blood-making viscera, it cannot be wondered thi4
the elaboration of the food should be bad, and the blood of a poor
kind. The secretions disclose this poverty in the thin mucus, and
the want of red particles in the blood. Yet as the same blood has
to supply the materials of the solids, we find a sad want of healthy
nutrition of the flesh, and all the signs of feeble nutrition of the
soUd composing the spinal cord. Here, then, is one cause of the
failing power of the will over the limbs. But further, the same
want of organic vigor, connected with' poor blood, prevails in the
blood-vessels of the spinal cord, and we have there, as well as in
the viscera, a greatly congested state : a congestion which also
aids to impede the free action of the will over the limbs. This
impediment applies exclusively to the portion of the spinal cord,
which rules the action of the extensor muscles : these being para-
lysed in great degree — their antagonism being in abeyance,—
the flexors enter into vehement, spasmodic action, and the limbs
become permanently bent.

Imperfect nutrition is thus seen to be the source of this com-
plicated malady ; and the organic condition of the viscera which
corresponds with that nutrition is the object of treatment, and has
been already signalized as one of feebleness, congestion and irri-
tation. All the cases that have come before me at Malvern had
been previously treated as rheumatic, that is to say, by sudorifics,
purgatives, mercurials, and hot baths : all which, the hot baths
especially, had considerably and invariably exasperated the dis-
ease. I never was inclined to try the common remedy for chro-
nic rheumatism afforded by the water cure, namely the sweating
process : but have no doubt that it would have proved detrimen-
tal, so clear is it to me that the disease is not rheumatism.

What treatment was pursued may only be briefly told, the ra-
ther as I have no cure to recite. In fact, this section is written
more with the intention of putting the reader on what appears to
me the right track, regarding the essential character of the dis-
ease, than with the desire to connect the water cure with it as a
curative. It is the most intractable and tedious malady in the
list of chronic ailments. Of the patients to whom I have alluded,
one has persisted in the water treatment Tor more than two years,
and is certainly better in the limbs, and very much improved in
general health : whilst the other, who has been under treatment
about eighteen months, has had the progress of the disease towards
utter fixation,* and helplessness, which was fearfully rapid, fairly

SPUEIOTTS PAL8T. 21S

arrested : and both, as they stand, are encouraging cases. Of
the other five patients I have lost sight : persons who have been
again and again disappointed, or rendered worse by various plana
of treatment, naturally become more impatient and distrustful : so
that when they come to the water treatment, and find no striking
alteration effected by it in a short time, they refuse to give it a
lengthened trial, and shrink from the annoyance of experiencing
another disappointment after another tedious process ; and who can
wonder or blame (hem ? However, I have every hope of curing
the two cases, in which a fair trial is being given. The treat-
ment of them has consisted in wet-sheet packing, daily and twice
a day, the prolonged douche, sitz baths, and large doses of water,
larger, indeed, than in any other disease ; compresses to the prin-
cipal joints, and to the abdomen have been incessantly applied :
the diet has varied between meal on alternate days, and total absti-
nence from animal food, which is in no case taken daily : all
liquids are kept scrupulously cold : and passive exercise in the
open air enforced. The amount of these means has been made
to vary according to circumstances : sometimes three or four
packings in the day are had : the douche has extended from one
to twelve minutes, &c. Occasionally the treatment, except a
shallow bath in the morning, and the large doses of water, has
been suspended for some weeks, to allow the system breathing
time, and enable it more freshly to react on the renewal of the
processes.

With the organic feebleness so marked in spurious palsy, the
tediousness of the treatment, and the great difficulty of rousing
tl\p system to critical efforts, might be predicated. And so it is :
in both the cases referred to there has been considerable swelling
of the feet, a dark red blueish swelling, extending some way up
the leg, which has persisted for many months ; yet not going
further, nor issuing in any extraordinary secretion and exudation,
as happens in most cases where a crisis in the feet occurs.
There is also the greatest tardiness in the appearance of even
superficial eruption underneath the heated compresses of the
joints. And it is equally difficult to cause augmentation of the
intestinal secretions, so as to constitute critical action in the in-
ternal parts. Still, inasmuch as an attempt is made by the
body, it behoves to patiently maintain and improve the power by
which it was made, until it shall be made with sufficient effect to
relieve the internal .congestion by which the nutritive energies of

CtH GBNERAL GAMGUOMiO ISBITATION.

the body are oppressed. That this is to be done by the .w«ter
ciire I believe, from the experience of these two cases ; and that
all other modes of treatment not only fail to do it, but.substaii-
tially increase the oppression, was abundantly proved in iUl the
cases which came under my observation. Meantime, my hope
is, that these few pages on the subject may at least mam soipe so
afflicted from boiling their bodies in baths and steam, under the
impression that they are suffering from mere rheumatism.

Other results o£ general gangkamc uriiation and congestion ate
tniceable in two or three chronic disorders, in which there is still
the want of nutritive energy that marks the disease last treated
of.

One of these disorders consists in an extreme sensitiveness of
the mucous membrane of the throat, mouth, and nostrils, which is
constantly gorged with blood, and comes off in shreds, but, withal,
is not parched nor affected with thirst. The mucous mem-
brane at the other extremity of the canal is in a similarly gorged
and sensitive state, and suddenly falls into Excessive diarrhooa
with the smallest nervous cause, leaving the patient in the ex-
tremity of weakness. And the whole of the abdominal viscera
evidence a like congestion and irritation, by the extreme facility
with which morbid causes, of diet, and especially of a mental
kind, produce feelings of distress there, though not the usual signs
of dyspepsia. • The head is most capriciously supplied with blood ;
sometimes the rush towards it, and the irregular circulation in It^
known by giddiness, drumming noise, &c., added to the red apd
turgid state of the face and scalp, show excessive amount of blood
in it ; at other times, this will suddenly change into extreme pale-
ness and shrinking of the face, and faintness, showing the de^
aency of blood in the head. Palpitation of the heart, and a sense
of " stuffiness " and constriction in the chest, are oflen experi-
enced, though yot simultaneously with the rushes of blood to other
parts. The limbs experience similar vicissitudes of power, hav-
ing now an almost supernatural energy, and again a tremulous
helplessness; whilst suddenly the feet or hands will become
swelled to stiffness, with or without shooting pains, but never with
redness, though with heat. The flesh is sofl, flabby, and small
in quantity. Except in the face, the skin is everywhere pak^
lifelsss ; nothiog, seems to rouse it, or oidy for a veiy short tnne,;

mmtMVB PAtsT. tt5

bat it is exquisitely alive to changes of atmospheric dectricity

and temperature ; it is scarcely possible to make it sweat. The
pulse is small and soA when there is no rush to the head, and
large and soft when there is. The sleep is a stupor ; frequently
broken, however, by some rushing of blood to the head, to the
lower bowels, accompanied by pain, or to the feet and hands ;
and then an universal pulsation is experienced. The mind is
irritable to the last degree, or else desponding ; rarely equable
and happy. In the midst of all this the appetite is tolerably good,
and its gratification to the full may bring on general abdominal
sensations, blood to the head, to the lower bowel, or to the feet,
but never acidity, heartburn, flatulence, nor weight at the stom-
ach.

In all this we behold a want of proper nutrition of the gangli-
onic nerves of the viscera, a state of congestive irritation and
feebleness which renders them unable to control the circulation
of blood, as is their function to do ; hence the caprice of the
circulation. But throughout, in the flesh and the skin, we see
the marks of poor nutrition ; and the varying power of the brain
and spinal cord, in the state of the mind and the will, speaks to
the irregular nutrition of those parts. And although dyspepsia
cannot be said to exist, there can be no question that the process
of digestion, in such a condition of the nutritive nerves, is not of
the healthy character that would insure good blood for the offices
of good nutrition ; and no fact of medicine is better established,
than that great deterioration of the digestive blood-making
function may go on without exciting any distress, or other aninud
sensation in the organs appropriated to it ; so far are we still
from the secret of the vital chemistry within us, although, as in
the state now under consideration, the effects are exhibited in
enfeebled and irregular functions generally, and deficient nutri-
tion of the organs generally. Neither is the state in question
referable to nervotisness, for the patient is for long periods together
as steady, in his nervous system as the most robust and the least
sensitive ploughman, the irregularities of circulation going on
with harassing vehemence meanwhile. In short, all we can say
of this condition is, that it is one of those numberless pnases of
disorder of the ganglionic or nutritive nerves by which their
power of regulating the circulation of blood in, and their nutri-
ticm of parts, is impaired ; and that the blood, thus deprived of
te general regulator, is called towards and congested in this or

S19 OBNBHAL OANftUONiO imftlTATIOir*

that set of oi^ans, according to the application of causte more or

less apparent. A peculiarity in it is the extreme susceptibility of
the viscera to the action of medicines of all lands, the smallest
allopathic and all the homoeopathic doses producing the greatest
possible tumult and distress ; it is unparalleled in any diseased
state I ever saw ; the smallest and the largest dose of an opiate
causes quite as much disturbance as the smallest or largest dose
of an irritant-^— calomel for instance. I have not met with a fair
^description of this malady in any account of chronic diseases, and
that is my sole reason for mentioning it here ; for, as in the last
disorder treated of, I have no complete cure to record. Indeed I
have only seen two cases of it at Malvern ; one of which, after
years of medication, was. considerably benefited by the water
treatment, is still pursuing it, and is now in better health than he
has been for ten years past ; and the other I lost sight of after a
trial of only a fortnight, the patient going home on some business,
and friends then persuading him, I presume, that water would
put an end to him sooner than physic. Should the former of
these patients quite recover, I shall make it known, as well as the
entire treatment of his case. Meantime, I trust that should the
account of this singular morbid condition call the attention of any
medical reader to it, he may add his quota of information to the
above. But he will not do so by calling up cases of what is very
indefinitely denominated "general nervous debility," and of
"general nervous irritability," states which differ, in many
essential particulars, from that which I have described, and the
treatment of which, by physic as well as water, also materiallv
<liiren.

DiSKASl* OF THB LIMBS. 317

CHAPTER IV.

DISEASES OF THE UMBS.

Oi^gaiifl which minister to yoluntaiy motion — ^Rheumatism ; how conneetod
with Tisceral disorder ; and with ezcessiye use of the limbs—Pasii^
of acute into chronic Rheumatism — ^Neuralgic Rheumatism — ^Transfsr
of Rheumatism ; objects and details of treatment— Cases of local, gene-
ral, and neuralgic Rheumatism— Gout ; rationale of its inveteracy —
Nervous Gout— Chalky Gout ; differences in character and treatment-
Is gout curable ? — ^Rheumatic (rout

After blood is formed, it is distributed by the agency of the
nervous system, and the last chapter spoke of the maladies of
that system, a very important part of which is the brain and
spinal cord. As these last, by the exercise of the thought and
will, control the movements of the limbs, I shall now proceed, in
physiological order, to mention those chronic diseases of the loco-
motor organs of the body, which have fallen under my observa-
tion during my experience of the water treatment. In doing so,
the advantage of having just treated of the organs of the nervous
system will appear : so much are the diseased conditions of those
organs mixed up with those of the limbs : — a complication, which,
in my opinion, has not been sufficiently appreciated by writers
on the disorders which form the subject of this chapter.

The maladies to be now mentioned are not confined to the
limbs, although I have headed the chapter as if they were : yet
in the great majority of cases, they are so confined, only exhibit-
ing themselves occasionally, in the trunk and head. Still more
rarely do they apj^ar in some of the viscera : but this is mostly
the result of improper treatment, that Is to say, of excessive
drugging, and is a superadded disease to that which shows itself
in the locomotor organs.

These locomotor organs consist of the muscles of voluntary
movement, the fibrous sheaths in which they run, the tendons or
sinews by which the muscles work, the general fibrous coverings
of the muscles, the ligaments composed of fibrous tissue, which
■anottnd and bind tc^ether the joints, the fibrous sheath of tiM

S18 RHB0KA11SM.

Bpinal cord, the fibrous sheath of the nerves of voluntary mo &>
ment ; and, lastly, the nervous matter of the spinal cord, ana of
the nerves which convey the commands of the.M^Z from it to the
muscles. All these tissues and organs are included in the act
of voluntary motion, and all but one in the painful diseases now
to be treated of. That one tissue is the pure muscular fibre, of
whose capability of nervous or circulatory disorder, we have no
evidence whatever. Palsy arrests its contractile action, but that
is from want of the stimulus of the will, and has its source in
diseased action in the seat of the will. Spasm and convulsion
exhibit its excessive action : but the* cause of these, too, is to be
found in the nervous matter of the spinal cord. A muscle wastes
because the cellular substance between its fibres is absorbed.
Or it increases because that substance is augmented : for if a
muscle be constantly and violently employed, it does not increase
in volume, but only becomes more compact, the great employment
of it causing waste of the cellular tissue, a tissue not necessary
for voluntary motion : really strong and active men having hard,
but not large muscles. So that palsy and excessive use of the
muscles both lead to slimness, the only difference being, that in
the former they are slim and soft from want of contractile action,
in the latter, slim and hard from frequent and strong contraction :
whilst, when moderately used, thfe cellular tissue is increased by
the augmented call of blood lo the part, and the consistency of the
muscular fibre moderately increased. In none of these, nor in
any other case, have we proof of substantial disease of the true
muscular fibre,— that tissue whose intimate arrangement, mode
of growth, and vital action, are among the most obscure points
of physiology. In the diseases of this chapter, therefore, we
have to look to the fibrous tissues connected with the organs of
locomotion as the seat of their morbid phenomena, and to the
nervous matter of the spinal cord as invdved, in a secondary
manner, in those symptoms.

Those diseases are rheumatism and gota : clumsy terms, which
give no sort of idea of the states they stand for, but consecrated
by time, although the products of a bye-gone pathological doctrine.
When signs of -both appear, the disease is called rheumatic gout.

§ 1. Rheumatism.
Gold and damp are the ordinary exciting oausea of

KBB17KATI8K. t^lg

The proximate cause is an inflatnBiation of the ■heaiha
and coverings of the muscles and large joints. But the predis-
posing cause is more deeply seated, and requires to be well kept
in view whei» reference is to be made to the treatment : indeed,
it is the most important consideration when we desire to cure, and
not merely relieve the chronic forms of this disease.

Supposing a man with perfectly sound digestive organs, were
to get wet when riding on the outside of a coach ; he might have
a slight cold in the head, or even a slight cough from inflamma*
tion of the mucous membranes of the nostrils and air tubes, or
he might have a febrile attack from congestion of the mucous
membranes generally, but he would not have rheumatism. But
suppose his stomach and liver, the latter especially, were in a
certain phase of disorder, the mouth bitter and hot, the throat in-
clined to be sore, &c., the same amount of wetting would cause
rheumatism. This result would further be aided, if the man was
in the habit of violently exerting his muscles. The explanation
of which is, that he has a certain irritation at the centre of nutri-
tion, which renders the nutritive energy of certain parts at the pe-
riphery — ^namely, the fibrous sheaths and coverings of the muscles
«— feeble, and their power of resisting external causes of disease
deficient. When cold and damp, therefore, are applied to the
skin, the blood is driven thence towards the parts most ready,
from their want of organic energy^ to receive and retain it, and
least able to resist its flow. Those parts are the tissues which
have been most violently employed, the tissues connected with
the organs of voluntary motion, the fibrous tissues of the muscles ^
and joints. In some persons these tissues are congenital ly weak,
the hereditary predisposition exists, and there is a morbid sympa-
thy always existing between them and the centre of nutrition.
These are they, who, from an early time of puberty on exposure
to cold, exhibit the results in pains of the limbs and loins, rather
than in cough or common feverishness.

Ordinary observation shows that such a process as the above
actually takes place in rheumatic attacks. Persons congenitally
subject to rheumatism are also congenitally bilious, more or less
dyspeptic, of irritable nervous system, and given to rapid and
vehement use of the muscular system. In those who have only
the accidental predisposition, it will still be found that it consists
in a state of more or less dyspeptic biliousness, which precedes
aad eooompanies the rheumatic seizure, and that they too are in

5120 RHEITMATISM.

the general habit of making considerable use of the muscles.
The laboring man who keeps his stomach and liver in a constant
state of irritation with spirituous drinks, salted meats, &c., who
uses his voluntary muscles hard and long every da^, is exposed tc
all kinds of weather, is the most eligible and the most frequent
victim of rheumatism : for in him the conditions of stomach, of
limbs, and of exciting cause, meet in all their strength. Hence
in places where perry and cider abound, the peasantry are
especially subject to rheumatism : in Worcestershire and Here-
fordshire there are few of the laboring men without it.. The
rich and idle man, on the other hand, whose style of diet tends to
the erection and maintenance of the same internal irritation,
whose skin, clad in all kinds of warming contrivances, is rendered
excessively sensitive to the minutest change of external tempera-
ture, arrives at the same rheumatism which the other extreme of
discomfort brought to the laborer. Both set up a certain phase of
internal Irritation, which renders the external surface accessible
to cold ; that is the great fact in rheumatism, and bears more
upon the treatment than any other. Why the rheumatism seizes
one joint or set of muscles more than another we know not posi-
tively : but we do know most positively that more or less diges-
tive derangement is present at the time. I never saw a rheu-
matic attack in which such derangement was not present previ-
ously to its commencement. And how often does it happen that
a patient, racked with pain, is instantly relieved, an iron band as
it were taken from his limbs, by a copious vomiting of bile or a
seizure of common cholera ? Again, what are the drugs which
usually relieve the acute attack ? calomel, which forces the liver
to pour out bile; opium in combination with calomel, which
arouses an amount of irritation within, that sometimes, though
very rarely, is thrown upon the surface in a relieving sweat ;
guaiacum and other highly stimulating gums, which act in like
manner ; and colchicumy which, irritating the whole digestive
canal and causing vomiting upwards, and enormous secretions
downwards, makes a diversion in favor of the particular phase
of irritation that led to the attack, and the pain is relieved. All
this points to the relief, to the alteration of action in the digestive
organs, and notably in the biliary parts of them, as the great aim
in the treatment of rheumatic disorder. Rheumatism is not a
mere inflammatory pain of the sheaths of the muscles : it is a
oertaiQ kind and amount of digestive irritation exhibited by a

RHBUMATISM. 391

certain kind and amount of fibrous inflammalioQ. Any odMr
view of it lefllte to the most absurd and disastrous treatment*

For, let us tracer the progress of acute into chronic rheumatism :
it is only the professional explanation of many a layman's stoxy
recounted to me. The medicines above mentioned, after rousing
in the digestive organs another phase of irritation, different ifrom
that which led to the attack, a phase attended with augmented
secretions, have thereby assuredly taken away the rheumatic
pain. I will say nothing of the other mischievous irritation they
have set up in its stead, but only observe that, could it be main-
tained, rheumatism would be kept at bay, whatever else might
happen. Some people do maintain it for a time by still dosing
with mercury, until neuralgia in some of its forms, or fulness of
the head, is induced. Others give up the remedy with the disease :
and then the artificial irritation caused by the drugs, fades again
into the old rheumatic phase, and this simply because this last
had never been cured^ but only masked by the treatm^t. Not
only so, the blood-vessels of the internal parts thus irritated, have
lost ground by the frightful excitement to which they have been
subjected, and are in a more exhausted, that is, a more irritable
state than before : the . internal cause has been increased and in-
veterated, in short. More than this ; the inflamed and painful
joints have been. subjected, during the attack, to the processes of
cupping, leeching, blistering, &c., processes which, whilst they
draw blood from the vessels, tend greatly to weaken their organic
energy, and render them more liable to distension and congestion,
and still less able to resist external agencies of temperature.
The consequence of all which is another acute attack : and ano-
ther : and another : each one longer than, but not so exquisitely
painful perhaps as, the former ; and for this reason, that the pain
has never entirely lefl the muscles between the attacks, and the
internal and external diseased parts, weakened by repeated
attacks, are unable to make that violent reaction they did in the
first seizure. With greater or less rapidity, therefore, both parts
sink into a permanently exhausted condition, a permanent morbid
sympathy is established between them, and chronic rheumatism is
established with it.

I declare in all sincerity, that the events of which the above is
an explanation, have been related to me by more than two dozen
sufierers from chronic rheumatism; the first attack, — ^then the
return of dyspepsia or biliousness ; the second attack— continued

&^^ KHSUMATISM.

blli6fUBlQM or dyspepsia— <iODtinued rheumatism. These .aro
what they relate, and thus are they explained.

*Bttt when chrome rheumatism is fairly established, the nervous
system of the spinal cord begins to act a part in the phenomena.
Something of this is seen in acute rheumatism, when, the patient
being perfectly still in the recumbent posture, involuntary and
eloruciating twitchings of the affected limb or muscle take place.
In this case, it is plain that the spinal nerves distributed to the
rheumatic part are so irritated by the inflammation of the hard,
unyielding fibrous tissues in which they run, as to convey to the
portion of the cord whence they arise, an amount of irritation
which renders its function irregular : the will is lost for the mo-
ment, and involuntary twitches occur. Now the frequent occur-
rence of this in repeated attacks, tends to establish disordered
function in the spinal cord, added to the fact that between each
attack the irritation is more and more firmly fixed, and that the
exercise 6f the will over the limbs becomes a more laborious
process. Meanwhile, also, it must be taken into account tha<
irritations are radiating from the original seat of the malady in
the viscera towards the spinal cord, and the brain too, and that
another cause for the implication of those nervous organs is thus
presented. Yet more : the sheath of the spinal cord, and of the
nerves as they proceed from it, is of fibrous texture, even as the
inflamed and pained parts are, and, by virtue of that well recog-
nized sympathy between similarly organized parts, is especially
liable to receive organic irritation from them : and that such takes
place is well known by the thickening, and in' some cases partial
ossification it has undergone in old rheumatic persons. But any
degree of morbid irritation existing in the fibrous sheath in ques-
tion, tends to interfere with the same function of the delicate,
highly organized spinal cord it includes. Finally, and in aggrava-
tion of all these causes, the usual medicinal mode of treating rheuma«
tism, by keeping the whole ganglionic system of nerves in a con-
stant state of worry, has a marked effect in disturbing the office
of the animal system of nerves.

From all these sources the brain and spinal cord, the latter
more particularly, derive irritation, which mingles sooner or
later, more or less, with the fibrous inflammation of the muscular
sheaths. In some instances, this implication of the spinal cord
dates from the first acute attack, and the phenomena dependent
on ttM disorder of its nerves are so prominent amid the piur^

BHBUICATISM. Mt

ifaeumatic symptoms, as to oblige the designation of newrtdgic
rheumatism to be applied : a malady cf some frequency and of
considerable tediousness. But in the cases of pure rheumatic in-
flammation, the nervous implication comes to be estahUshedy only
with the establishment .of the continued chronic state : as I have
said, there are signs of its temporary existence in the acute state.
In the chronic malady, it is exhibited first, by some slowness in
making the muscular movement follow the will: then by in-
creasing rigidity and intractability of the muscles, especially of
the flexors, increasing the fixation of the joints : aud at length by
complete paralysis of the rheumatic limb. In the brain, too, the
evidence of strong irritation, proceeding from the sources I have
mentioned, is given by the occasional occurrence of apoplexy f a
not very infrequent termination of a rh'eumatic existence, and
hastened by the mercurials and iodine in such excessive usage by
routine practitioners, who stand aghast at the catastrophe, and
''wonder what apoplexy has to do with rheumatism," ^as I have
heard one say.

Such, then, is the progress of rheumatism from its first acute
attack, to its chronic tenancy of the muscular sheaths and joints.
Beginning in visceral irritation, it is not called rheumatism until
it has seized upon the fibrous textures of the voluntary muscles,
whence, as well as from the irritated viscera, morbid sympathies
radiate towards, and involve the centres of the voluntary nervous
system, the brain and spinal cord : the malady becoming more
complicated as . it proceeds. But other complications sometimes
take place in consequence of violent drug treatment, which need
only be very briefly alluded to here. One is with the hearty
and most commonly follows on the use of mercurials and colchi-
cum, the excessive irritation which they produce in the visceral
ganglionic system re-concentrating the whole mischief there,
and withdrawing it from the joints whither nature had driven it ;
and it more especially fixes on the heart, because it is the largest
internal muscle, and includes fibrous tissue similar to that of the
external muscles and joints. This is commonly 4^11ed a meta^
stasis, or transfer of the rheumatism to the heart: but it does not
appear with this explanation in the writings of practitioners of
the ordinary medication, because, I presume, it does not appear
to them possible that medicines can ever do mischief, and they
never think of putting the question regarding them.* Another

* That this opinion regarding the canse of the sapposed transfer to the

2d4 RHEUMATISM.

event, dependent on the same cause, is the d;opsical irritation of
the fibrous membranes which line the chest and abdomen, the
pleura and peritoneum, producing a very serious complication of
dropsy of the chest or lelly*

Now I strongly maintain that these dangerous additions to the
rheumatic disorder would never occur, if proper regard were
had to the fact, that it is only an external signal of internal vis-
ceral irritation ; that, in short, nature throws a portion of this
irritation from her vital parts within, in order to save them, upon
the external parts that are not so essential to life. For then we
should not apply irritants to delicate viscera already irritated,
rendering almost certain the transfer of the external disorder to
some internal part ; but we should strive to hring more and more
of a full circulation to the outer skin, in order to relieve the inner
skin, or mucous membrane, not to attempt to drive it to the exte-
rior by stimulants applied to the interior.* This last is the parent

heart, was held by me whiht yet profesaing the ordinary mode of treat-
ment, and before 1 knew anything of the water treatment^ will appear
from the following passage from my work entitled " The Simple Treatment
of Disease,*' published under the circumstances above printed in italics.

•* Much has been said, of late years, of the transfer of rheumatic inflam-
mation of the limbs, to the fibrous membranes of the heart. Like all oc-
currences that are lengthily insisted upon in voluminous works, written
' for the purpose of proving them, it is highly probable that the metastasis
in point is less frequent than is supposed. I am led to make this remark
from the fact, that out of a vast number of cases of rheumatism of the
limbs which I have treated and seen treated, I can only testify to seven or
eight, in which there waiS actual and indisputable ground for asserting such
transfer, for which, meanwhile, I was looking, and against which I was, in
my own practice, prepared to act. An instance of the transfer to the heart
was shown to me a few months back by a brother practitioner. There
certainly was pain, palpitation, &c., of the heart, but as the patient had
been, and was then taking large doses of mercury and colchicum, I ven-
tured to suggest the cessation of these, and the application of mustard fo-
mentation over the pit of the stomach, whereby the heart was soon freed
from pain, though it continued to be very irritable. The medicines, in
fact, had produced sympathetic irritation of the heart ; and this I believe
to be often the only transfer that occurs. It may, however, predispose the
heart to the actual metastasis, and, in such case, presents another practical
argument against violent medication of the viscera in rheumatism."

* A late writer on rheumatism, Dr. M*Leod, remarks, that free sweating
fails to bring any permanent or great relief : nor is it likely to do so, whilst
it is forced by such means as opium, antimony, calomel, and stimulating
spirituous tinctures and liquors : the patient is only sweating off the irri-
tation caused by the drug, not the original one : thai must be removed by
a more fMiwral process of sweating.

BHEUMATlStf. 220

of all the subsequent niischie& : it inreterates the rheumatism,
it hazards its transfer to vital organs, and it causes its complica*
tion with the animal nervous system. As long as this is done in
acute rheumatism, there will be abundant cases of the chronio
form seeking restoration from the water cure, which, were pa-
tients wise, would be their first and not their last resource, as it
now is, the wet sheet being held before them in ierrorem.

In treating rheumatism by the water plan, I look upon the mus«
cles and joints as altogether of secondary consideration : the rod
of the disease is not there. To give them the soothing advan*
tages of wet compresses constantly applied is right and expedient :
but all the compresses in the world, just as all the blisters and
leeches, will not cure rheumatism ; they take the edge off acute
pain, and may even suspend it, but it returns so surely as the in-
ternal cause still remains. It is thjat cause which it is the object
of the water cure to obliterate, t<Teject. Now, as the external
inflammation is the result of an effort on the part of the internally
inflamed parts to throw their disorder from them, so the water
plan of treatment places them in the best position to do so. It
withdraws irritants from them, it applies cooling dilution to them,
thus leaving them unoppressed in their salutary efforts : and at
the same time it puts the entire skin in a condition that renders it
the ready recipient of the internal irritation, in place of the- parti-
cular fibrous tissues. Hence it often, indeed generally, happens
that at the commencement of the treatment of chronic rheuma-
tism by water, there is an aggravation of the pains : the inner irri-
tation being more completely and vigorously brought out, and the
fibrous tissues being, as yet, the weakest and the most accustomed
recipients of it. As the treatment progresses, however, the uni-
versal skin becomes more freely supplied with* blood and organic
energy, and the internal irritation is thrown more upon it, and by
degrees less on the old diseased tissues : the rheumatism diminishes,
as the circulation in the skin increases. Patients whose skin has
bee^ for years stranger to sweat, now are made to perspire readily,
and the parchment color of the skin begins to give place to a
healthier hue. And both of these, for a reason which is further
exhibited in the occurrence of nausea, vomiting, or purging, or all
three, generally of bilious matters : that reason being the diminu-
tion of irritation in the digestive viscera, to an extent which allows
them to make this demonstration of self-relief. These augmented
internal secretions going on simultaneously with augmented cuta»
11*

826 RHBTTMATISM.

oeoils 8ecreti(mB, the Tisoeral caose of the rheumatigm Is thrown
off, whilst a diversion is made on the entire skin in favor of the
muscles and joints. This diversion also acts favorably on the
kidneys, by carrying off through the skin a quantity of saline aod
albuminous matters which had previously either passed through
. the kidneys and produced irritation there, and loaded urine thence,
or had been retained in the circulating blood, and deposited in lar-
ger or smaller quantity in the fibrous tissues of the joints, and
tended to their fixation. Such elimination through the skin, in
the course of the water treatment, is abundantly proved by the
character of the perspiration itself, as well as by the very much
improved state of the urinary discharge, which at an early stage
of the treatment becomes lighter and clearer. In this manner all
the viscera implicated in the rheumatic disorder are relieved
of their irritation, and put in the best position to throw it entirely
off by some of the chief emunctories ; so that once ejected, there
is no more rheumatism until the viscera are again exposed to mor-
bid causes : the Umbs may be exposed to cold, as much as you
please.

All these efforts and all these results being wrought through
the instrumentality of the nutritive nervous system, it behoves to
look to that portion of it which is represented by the brain and
spinal cord : the rather, as we have seen how these last are
sometimes implicated in the rheumatism, and are therefore in a
morbid state. That state is one of active irritation and functional
excitement in the kind of rheumatism denominated the neuralgic :
and is a state of functional oppression, of partial paralysis, when
it forms part of the disorder of very long standing infiammaUny
rheumatism. In the neuralgic kind there is too vivid circulation
in the spinal cord :' in the old inflammatory there is diminished,
congestive circulation. The vigor, therefore, with which the
treatment is pushed so as to rouse the nutritive energies, and the^
means taken for that end, will vary these two. conditions of the
animal nervous system. It would neither be expedient nor ^afe
to employ* the sweating process, for instance, so oflen in the neti*
rdlgic as in the old inflammatory, species, if, indeed, it were fit to
use it at all ; nor to drink so much water, dec, &c. ; but rather
to have recourse to the wet sheet, and other soothing and lower-
ing appliances. The animal nervous system, in short, ought not
to be subjected to the same amount of excitement, nor should the
amount of <%fibrt be induced in the neuralgic as in the

IBBUXATISM. S27

purely rheumatic disease ; at least, it ought rut to be induced so
rapidly ; and that is one reason why neuralgic rheumatism is
usually more tedious than the other kind. If you stimulate sud^
deiHy and vehementlyj and cause the nutritive nerves to enter
quickly into eflfort, you run risk of augmenting the very condition
of the animal nerves which forms so great a part of the disorder :
however this may act on ihejihrous tissue, it will have the effect
of aggravating the irritation of the nervous tissue, and the tic part
of the malady will remain, although the it^lammaiion of the joints
may be diminished. But even in genuine fibrous rheumatism,
where the animal nervous system is involved, and in a state of
diminished function, care should be had not to put too sudden, too
great, nor too prolonged a strain on it by the means of the treat-
ment. More may be done in that direction in this species of
rheumatism than in the other : but the condition of the head
should regulate the amount, and should be scrutinized as we
proceed, by the aid of the pulse, the pupil of the eye, and the
state of the external senses. Whilst some of the means are re-
ducing the visceral, we must see that others are not exciting too
much the animal nervous irritation, so that this shall recoil upon
the viscera, and at least leave the patient stationary, at worst
increase all his ailments.

Similar considerations regarding the animal nervous system
lead to diverse advice regarding mental and bodily exercise in
the cure of rheumatism. In the neuralgic kind it is not so de-
sirable to make strong and long efforts to exert the limbs as in the
fibrous kind : neither can so much be expected from the artificial
exercise of frictions about the joints, in the former as in the latter.
A fact not sufiiciently recognized, is, that afiections of the mind
have a marked effect upon chronic rheumatism. I have often
seen the limbs rapidly rendered useless, from increased pain and
stiffness on the supervention of some disagreeable or anxiety on
the mind. This applies more to the neuralgic kind : but I have
seen it in both kinds. It is a fact of considerable importance in
the treatment, and should be weighed i.i the balance of the chances
of recovery, both by the patient and the practitioner.

Thus it will be seen that chronic rheumatism^ deriving its origin
from an intense irritation of the digestive viscera, and involving
the fibrous and the animal nervous tissues of the body, is a dis-
ease the treatment of which, with a view to cure, includes nice
opnsiderations. Indiscruxiinate sweating and douching, and water

328 RHEUMATISM.

drinking, and walking (when that is practicable), are not all thai
is required, as one might be led to think from the early publica-
tions on the subject in this country. Sweating, indeed, is rarely
indicated, and tends rather to augment the internal origin of the
disease : it is only when there are signs of indolent, obstructed
hver, that it is admissible to pursue it for a long time together:
the wet sheet should be made to alternate with it. And so of
water drinking and douching, which are both exciting processes :
they require to be nicely regulated by the condition of the ner-
vous system, the neuralgic rheumatism, for the most part, not bear-
ing a large amount of either so well as the chronic inflammatory.
But in both kinds, l^e great remedy is the wet-sheet packing,
which should be practised throughout the treatment : at first alone,
and for the purpose of directly subduing the visceral irritation :
and subsequently, when the tonic and stimulating processes are
employed, for the purpose of obviating any super-excitement
which they may produce to the detriment of the viscera. For
like purposes, hot. fomentations to the abdomen are good, especially
in the onset, when there is, in the great majority of cases, no
small degree of extra irritation, arising from previous habits of
diet and physic, to remove, before arriving at the old mischief
which had been thus masked. In the neuralgic rheumatism, more
particularly, these two applications are commendable : I have
often seen exasperation of the pain from atmospheric and electri-
cal vicissitude quickly relieved by abdominal fomentations alone.

Except these fomentations, the applications should all be cold
at least, the aim should be to bring them to that state. Undoubt-
edly, in some very long standing cases, where nutritive dis-
order has gone to the extent of bloodlessness, the temperature
may be graduated to the low reactive power of that condition,
and beginning with tepid, it should be judiciously decreased.
But if there be one canon of treatment more binding on the prac-
titioner than another, it is that which enjoins the use of cold, and
the avoidance of hot baths in chronic rheumatism : there is no
more certain way of inveterating that malady than the parboiling
which so many undergo at hot springs ; and this because it both
debilitates the digestive function, and renders the skin more sen-
sitive to external influences.

So also in the affair of clothing, it is desirable to avoid all ex-
cess of warmth, and thereby cultivate the reactive energy of the
•kin, which jb so necessary an aid to, as well as consequence o(

RHEUIilATISM. 2220

the improvement of the digestive energy. But here, too, refer-
ence must be had to the full or bloodless condition of the patient,
and the former coverings removed gradually, — sometimes, even
by tearing off portions of a flannel under waistcoat from time to
time, or taking advantage of a warm day or two to make an ad-
vance in the stripping process. It is only in comparatively recent
cases that you can doff the accustomed under clothing at once.
A good rule even in these is to lei it remain for a week or so
after the commencement of the treatment.

No chronic disease is more certainly curable by the water
treatment than rheumatism : except perhaps some forms of dys^
pepsia and nervottsness. There is the greatest discrepancy as to
the time requisite for recovery, nor is it very easy to predicate on
the subject, some of the most unpromising cases rapidly giving
way before the treatment — ^whilst a circumscribed one turns out
to be vastly tedious. In fact, I have often observed that when
the pain is confined to one or two joints it is harder to get rid
of : as if the concentration of visceral sympathy on those two
joints rendered its removal to the entire skin more difficult. Age
has also some influence on the length of treatment : after the fif-
tieth y^ar, one is obliged to spread the treatment over more time,
because the body is not so apt for strong reaction. I have noticed
that women are longer in recovering than men : probably from
the neuralgic element entering more into the essence of the dis*
ease in them : for thai again influences the time of treatment,
that form of rheumatism being more tedious than the purely
fibrous kind. But in any case, it is better to look forward to a
somewhat long treatment, which is both safer, and more sure,—
safer as regards the nervous system, surer as regards the eradi-
cation of the visceral irritation. Altogether, the time may be
said to range from three to twenty months.

I never treated chronic rheumatism in a person hereditarily
predisposed to it : but I should doubt its curability under that cir-
cumstance, yet should not doubt that means exist in the water
treatment to stop its progress to utter fixation of joints and loss of
locomotive power, as well as to arrest any acute exasperations of
it. I give two instances of chronic rheumatism, one. of a local,
the other of a general character.

Case XXIV. — ^Rheumatism of the Kkee Joint.
The patient in this ease could give no very clear account of the oiiglii

290 RHSTTMATISSC.

of his malady. He was yonn^, only twenty*five yean, and when,
it began, nearly two years before he came to me, he did not pay particu-
lar attention, nor give particular care to it He travelled in the East,
and in the North of Europe, and had undergone a good amount of fatigue
and exposure, and his bodily system altogether had been deteriorated.
He was at Oxford when the rheumatism of the knee commenced, and it
flocm forced him to walk lame from stiffiiess. An acute attack of a very
bayage character, accompanied by enormous swelling and exquisite ten-
dnmess of the left knee joint, followed this stiffiiees ; leeches and lotions
formed the local, and calomel and opium the general treatment, saline ^
purgatives and nauseant emetics aiding. By these appliances and rest,
the acute inflammation was converted into a chronic one, with which he
went about as he best could, without prevention by diet or any other
means, and with only some sort of plaster, spread on leather and strapped
round the joint. As ought to have been expecte^ a small amount of ex-
ercise renewed the acute inflammation, which was again reduced by the
same means as before, only with more of them, and with much greater
difficulty. Also, the knee was much less able for exercise than betbre.
This alternation of acute and chronic inflammation went on for many
months, the acute attacks becoming nearer and nearer, the state of the
knee during the chronic stage more disorganized and painful, and the
use of the liinb more and more curtailed.

In the course of the treatment to which he was subjected in the acute
state, besides leeches, blisters, tartar-emetic cerate, all kinds of irritating
liniments and poultices were applied. During the chronic intervals per-
petual blisters, moxas, mercurial and other plasters, mercurial and iodine
frictions, &c., &«., were continually in requisition. During both phases
of the disease the genera' treatment consisted of mercury in various
shapes (he was salivated t^ice), of iodine, of which he took several
courses, of iron also several courses, of opiates in all shapes, of purgatives
in all shapes, of vegetable tonics in all shapes. But the most striking
system of prevention and cure of this inflammatory disease was one which
•was practised towards^ the close of the patient's drug experience, and
consisted in complete rest on the sofa in a warm room, strong doses of iron,
and a diet cf coffee, cooca, rump steaks, jellies, turtle soup, bottled porter,
and port wine. And this at a time, when swinging the limb between
two crutches brought on intensely acute inflammation !

Under such a monstrous r/ gime as this (monstrous, although the pa- •
tient had the advice of the chief metropolitan- surgeons) the safety of the
whole left leg became imperilled. For six months the patient had de-
sired to try the water curfe under my care : but his friends, on the assur-
ance of his tnedical adviser, " that it wtmld insure his deatk,^' prevented
him. At length, this same adviser became alarmed at the appearance of
the leg, and the ruined health of the whole body, and declared to the pa^
tient, ** that there remained no remedy hut amjndationP As the safie)rer
iMlRradto roaUie risk^f death from the water cnre>tatfae ctrtaintyof

loniif Mil leg by tihe knife, he came to Mahem into my esteblidmieiit at
the end of Jannary, 1844.

I found the knee swollen to Aree times the natural size, and the disor*
ganized state of the skin and tissne underneath gave proof of the frightfol
usage to which it had been subjected. The joint was in every part ex*
quintely sensitive to pressure : the aligfatest attempt to bend it more (it
was always shg^tly bent) gave great pain : and in locomotion he was
eompeiied to bang the leg by a ribbon round his neck, and go on two
crutehes, Thisheluddomfor aeveralmonihs. But, bad as all this waa,
the inspection of his viscera, and the history of the treatment just given,
explained it all. I found his digestive organs in a fearful state of irrita«
tion, and his liver- gorged : the split, swollen tongue, spongy gums, sore
throat, all bespoke the visceral cause of the local disorder, and also ^b»
havoc which medication had perpetrated. Everything about him showed
the same, by the deteriorated nutrition and function of the organs. He
was emaciiUed, paUid, tremulous all over : the excretions of his bowels
and kidneys were exceedingly disordered : he could not bear a faneath of
air, and his skin was always crawling and shivering : he had not a ves"
tige of I4)petite, and had all along been swallowing the rump steaks, and
other delicaciee, moUgri his unfortunate stomach : when in bed he could
not sleep for pain, and when out of bed he had, besides pain, an intolera-
ble sense of irritation and restlessness : his spirits were utterly gone : he
was a miserable, broken, snaring man.

It was very plain to me that he had come to this pass by having all
the attention of his surgical advisers turned toWards the knee ; his vis-
cera being, meanwhile, made the sport of the absurd treatment I have
described. The knee bad been rendered worse, and maintained so, be-
cause the viscera had been kept in a blaze. As my own observation
and convictions always lead me to look for a visceral cause of a chronic
local malady, I paid very slight attention to the knee in the present in-
stance. I luew and tdd the patient that I should not treat that, for there
was abundance of more serious mischief to get rid of. Accordingly I
merely placed a thick, wet compress, wrung out of cold water, round the
knee, and from first to last it never received any more treatment. But
against the vast amount of visceral derangement, I directed all the febri-
fuge and counteracting means of the water cure. Being young, and
having a great deal of feverishness, he was at ouce and vigorously packed
in the wet sheet, at first once, then twice a day, and subsequently in two
successive sheets morning and evening : the cold shallow followed them as
usual. For ten or twelve day's he was fomented on the bowels each night
for an hour. He wore the compress on the abdomen day and night. He
drank after a week's treatment ten tumblers of water daily. For a fort-
night I kept him without animal food, giving plenty of farinaceous : his
only beverage was water.

For months before coming to me he had moved, when he dared to move
«C ill, <» two crutches, with his leg suspended. At the end qfibafourik

2S8 RHEUMATISM.

toedc cfthis hi^ieTnc treatment, he toaOced with the support cfa stick: and
at the end of the fifth week wUhovi any support at all. And why ? because
long before that time the mucous membrane had been disgorged, the
liver had poured out bile abundantly, the urine had been restored, the
skin had recovered its vitality to a great extent^ the sleep and the spirits
had been recovered, and he had eaten and digested large quantities
of plain, nutritious food : — ^the viscera had been relieved and the knee
must follow. Still, he walked tenderly on the left leg, and avoided pres*
sure on the knee. But it was not necessary to alter the treatment, save
in the allowance of more and stronger food in proportion as his power
and extent of walking increased, and except that, after two months, he
took the douche three or four times a week. By the end of those two
months, he could walk to the top of the highest of the Malvern hills, and
usually went over ten, twelve, or fifteen miles of space daily. Mean-
while he grew in flesh and fJEit ; and so far from fearing cold, would often
walk in March, with an easterly wind blowing and the rain descending,
without his hat The knee shrunk until the bone was only covered witii
skin.

It is unnecessary to pursue this case any fuither. The patient re-
mained with me two months after all signs of disease in the knee
had disappeared, for the total restoration of his general health. Little
more than a month ago he wrote to ine, stating that he had. never for
an instant had the smallest difficulty or inconvenience from the limb,
or in his general health since he left Malvern, eighteen months before.

The history of this case before it reached' me is that of the
great majority of rheumatic patients, and it amply demonstrates
the folly of treating rheumatism as a disease of the limbs alone.
Nothing, literally nothing, but a damp bandage was put round this
joint, which had been for many months the subject of bleedings,
blisterings, &c., under which it went from bad to worse, because
at the very time when these counteracting agents were applied to
the skin, irritating agencies were proceeding from the viscera
towards the painful joint: between the two, the knee became
more and more weak in its vital selfl restorative power. Had it,
in the first acute attack, been kept cool and perfectly rested, and
had low diet been prescribed, instead of the calomel (for which
there was as much occasion as there was for a poisonous dose of
arsenic), months of sufiering, with peril of the entire limb, would
have been avoided : the best physician, Nature, would have res-
cued her organization. And yet it is heresy to protest against
•uch blundering medication !

Here is the short history of a case of general rheumatism, where

RHEUMATISM. 288

the visceral irritation arose more from food than physio, and where
the muscular sheaths became the seat of disease, for the reason
that the patient made long and strong use of them in his labor.

Case XXV. — General Rheumatish of the Bodt.

A &rm laborer, fifty-five years old, living in a low damp sitoation and
on a clay soil, became rhemnatic &ve years ago. When he ate meat it
was always salted : he devoured heavy paste paddings ; and he drank
freely, although no drunkard, of thin acid beer. The action of this food
(HI the stomach, and of the cold damp on the skin, did not bring on a
severe acute rheumatism, but it stole on him gradually, slight febrile at-
tacks marking, from time to time, the attempt at an acute fit The dis-
ease crept over him, however, stififening his loins and hips, then the
shoulders, then the knees, and so on, until there was scarcely a moving
point which it had not visited. All this time he grew more sallow, yel-
low in the eye, giddy in the head, and somnolent : the kidneys gave out
dark and turbid urine : the bowels were constipated and their excretions
light colored : all the symptoms, in short, were those of great biliary and
digestive derangement. He had swallowed plenty of ^ doctor's stuff"
from the Dispensary, had abundance of things rubbed on his body, and
had taken pounds of Epsom salts on his own account : but the progress
was still downwards. The poor fellow's family was in danger of starv-
ing from his impaired powers, when he was sent to me by the benevo-
lent aid of a gentleman, who had derived benefit from my treatment
He could not for upwards of a week be packed in the wet sheet, so
' much was the vitality impaired : and until then the treatment was con-
fined to hot fomentations at night, and rubbings with the dripping sheet
twice a day. At the end of ten days, he was partially packed in the
wet sheet once daily : fomented at night : had a rubbing sheet at noon.
He drank seven tumblers of water in the day : and from the begiiming
his diet had been of bread, rice, and farinaceous matters. He had not
continued this plan more than a week, when a smart attack of acute
rheumatism took place, and every joint in his frame was implicated. I
had expected this, and it will be found to occur in the majority of cases
of old rheumatism treated by water. It is only an increased efifort of
the viscera to throw their irritation on the limbs, and, when so induced,
is ratlier to be hailed than feared. In the present instance, the attack
only caused me to make more frequent use of the wet-sheet packing : it
was taken twice in the morning and twice in the evening, the cold shal-
low bath following both, and the fomentations in addition after the even-
ing one. But, although he was racked with pain he lost but little sleep,
so much did this treatment keep down fever and restlessness. The at-
tack &ded after ten days' treatment, and its retreat was accompanied by
an enormously increased action of the kidneys, which poured out watei

it94- ftHSUBLiTISM,

diai^ n^th aiiUa and mncuB : and this pm^gation of- the kiilneyB eon
tio^ied more or less for a fortnight. Meantime the chronic pains wen
still present, but had been reduced in position to the loins and the knees.
This was accounted for to me, by the greatly improved complexion of
bis skin and the more free flow of bile through the bowels, as well as by
the urinary purging alluded to. The visceral irritation, in fieict, was con-
siderably relieved, and the external parts in exact proportion.

Against these remaining chronic pains, I continued to apply the wet-
sheet packing every morning, except two, in the week, when he was
sweated. A cold shallow bath of four or five minutes was taken aiter
eadh. He was also well douched once a day &t noon, and had a sitz bath
of half an hour in the evening. He drank ten to twelve tumblers of water
daily : and wore wet compresses on the knees night and day. Exercise
was taken as much as the limbs would allow. Animal food was allowed
every other day. In about three weeks of this treatment, the liver was
roused to fresh eflforts at reHef : but this time they were not thrown upon
the limbs in the shape of acute rheumatism, but were exhibited in
nausea, which, after a few days, went on to vomiting of bilious and acid
liquids two or three times daily. The bowels were also affected with
bilious purging. I allowed this to continue for more than a week with-
out altering the treatment : after which the wet sheet was discontinuell,
and the sweating used twice a week : all the rest going on as before.
This kind of internal crisis had released the loins almost entirely from
pain, and the knees to some extent also. But my personal .superintend*
ence of his treatment ceased at this point : for he was obliged to return
home. He continued the morning ablution there : sat in a tub of coW
water once a day : had the knees well pumped upon every morning and
evening : sweated once, and was packed in the wet sheet twice a week :
and kept up the doses of water : in all which he showed an enlightened
perseverance which one often seeks for in vain, among those who lay
claims to be the " betters " of this poor man. He was ten weeks at
Malvern, and continued to practise the water treatment for more than
three months after his return home, by which time he had lostiill rem-
nant of it in every part of his frame. More than two years have passed
sjnce that period, without any return of the disease, although he inhabits
the same damp situation as before ; — biU he has learned hno to save his
viscera, and thereftrre the cold damp no longer causes rheumatism.

Case XXVI. — Geneeal Rheumatism with Nervous Signs — ^Neu-
ralgic Rheumatism.

This case resembled the last in all particulars, except that the patient
was twenty years younger, was a highly educated person, Vith a sensi-
tive and largely developed head, had been affected with rheumatism
seven years, and had certain symptoms indicative of spinal disorder.
The visceral cause, too, in this case was to be found in digestive irrita

EHEUXATiSM. 9t6

AuL arising from stodioiu and sedentary habits, and finom frequent mer-
enriab taken to obviate the results of those halnts. His complaint be-
gan with an acute attack of rheumatism, which, treated with mercury,
opium, and colchicum, glided into the chronic state, and went from bad
to worse, amid the farrago of means proposed and adopted. But the
finely organized nervous system of this patient soon caused the implica*
tion of the spinal cord, and the legs, besides having their power curtailed
by pain, had it also diminished by actual want of voluntary strength.
This was evident from the fiict that when the pain very much diminish-
ed, as it sometimes did in clear, bracing weather, the command over the
limbs was equally deficient It also varied with the condition of the
wind, with. electrical changes, and was much afiected by sleep, being
less for some time after it, as if the spinal cord were sldwtoawaJEe fully.
There was not much swelling of -the limbs or joints (and this is always
the case when the nervous element enters greatly into the rheumatism),
but exquisite sensitiveness, with, very often, r^ neuralgic pain in a
small point of a joint where no unusual signs of inflammatory rheuma-
tic action existed.

The principal difference between the treatment adopted in this case,
and that pursued in the last, was that sweating was altogether avoided,
ai it tends to excite the animal nervous system. Reliance was chiefly
placed upon the wet-sheet packing twice a day, and fomentations of the
abdomen at night, and wet-sheet rubbings twice between the packings.
The diet included some animal food once in the day, and excluded any
voluminous vegetable matter, such as greens : for nervous dyspepsia is
implied in neuralgic rheumatism, and will not tolerate the stimulus of
bulk. Water was drunk to the amount of ten tumblers daily. In most
other details he did as in the last case, and I shall therefore not recapitu-
late. Towards the close of his time at Malvern, the douche was admi-
nistered with decidedly good eflect : but that was after the stomach irritaf
tion had been almost got hd of. Yet the case was a tedious one. The
patient worked hard at the treatment at Malvern for nearly four months,
and by that time had become erect instead of bent, could walk ten times
the distance he formerly could, slept better, and could command the limbs
at all times. There remained frequent neuralgic shootings along the
limbs, with a lingering of pain about the joints, evidently of a nervous
rather tlian inflammatory kind. Against these, he continued the daily
packing and dripping sheet, with the water drinking, diet and exercise,
for four months longer, at home, and has now remained more than a
» year perfectly free from pain, although from prolonged fear and pain of
using them, there still remains and will probably always remain, some
degree of stifi* movement of the knees. But for all the active purposes
of life, and in regard to the absence of all pain, he is cured.

d86 GOUT.

§ 2. Gout.

The observations on the visceral origin of rheumatism ap|dy
still more forcibly to gout. The digestive disorder antecedent to
an outbreak of the disease, the immense relief felt by the digest-
ive organs afler the fit, and the great and alarming distress of the
viscera, when they do not possess the power of throwing it out
on the limbs, point beyond all question to the origination of gouty
disorder from within. As in rheumatism, also, the biliary organs
are especially afiected : and the bitter mouth, yellow tongue and
eyes, white evacuations from the bowels, and dark evacuations
from the kidneys, show the derangement of the liver and duode-
num. A certain amount of irritation is eMablished there by re-
peated stimulation of food, and Nature makes the effort to throw
it on the external fibrous tissues : a good deal of stomach disturb-
ance attends this efibrt. If she succeeds, a fit of gout ensues,
and the digestive organs recover themselves. If she does not,
those organs continue in a state of extreme disorder, and the irri-
tation is so great as to involve the heart or brain, and may, ifl
fact, be transferred to them, producing the dangerous condition
called gout in the head and gout in the heart ; or, being concen-
trated in the stomach, constitutes the equally dangerous spasm
of that organ called gout in the stomach. At other times the fail-
ure of the natural effort to throw off the gouty visceral irritation,
or, as it is commonly called, the suppressed gout, causes a minor
but more incessant disorder of circulation and distress of function
in the head and heart ; and hence the nervous condition of mind,
the headaches, giddiness, faintings, palpitations of heart, dz^c,
that attend the suppression. Grout in the toes and fingers is the
desirable consummation of this disorder : the centre of life, the
viscera, must he saved. The ordinary medicinal practice reverses
this and perils the patient, whilst it perpetuates his disease. It
will help an explanation of the aims of the water treatment to
say a few words on this point.

When the patient sends for his medical, attendant, Nature has,
usually, already thrown her visceral disorder on the limbs : acute
pain and inflammation are present in the nervous and fibrous
tissues of the toes or fingers. The ordinary remedy is either
some form of mercury, or arsenic, or colchicum. These, the last
especially, are almost certain to reduce the pain, and not unfre-
quently with great rapidity: dry warmth being, meanwhile.

GOUT. Wt

applied to the sensitive limb. But the pain is not reduced onlesi '
the digestive canal give evidence of having been irritated in the
shape of more or less diarrhoea, the presence of thirst, dryness of
tongue and throat, nausea, or actual vomiting, dz;c. Neither in
such case is there that great appetite and sense of general relief
which attends after a fit of gout that has wasted Itself, or been
treated by the expectant method. More or fewer of these signs
will be observed by any gouty patient, who looks accurately into
his sensations after an attack thus removed. To the patient, and
indeed to the physician, who knows little of physiology, all this
will appear right : the gout is removed, and that is what was
desired. The physician, however, who is a physiologist, will
say : " True, that irritation which you call goui has left the ex-
tremities, whither it had been sent by Nature to save her noble
internal parts. But look to the signs exhibited by those parts ;
are they not those of augmented irritation, at least of irritation of
a degree and kind, that did not exist so long as the limbs were
pained and inflamed ? The fact is, that your colchicum has set
\ip in the viscera so intense an irritation, as to reconcentrate the
mischief within, and the fit is cured, not by ridding the body of
tne gouty irritation, but by driving or drawing it in again.
Hence, the continuance of the dyspeptic symptoms after the fit ;
hence, as you will find, the recurrence of another fit ere long, the
intervals becoming less and less, until gouty pain is incessantly in
the limbs, and gouty irritation always in the viscera ; and henqe,
the gradual but sure enfeebling of the viscera to the point of
inability to throw any of their irritation on the limbs, and then
comes your gout of the head, of the heart, or of the stomach, and
carries the patient off. All this happens becaus^ you have
meddled with, instead of following the indication given by
Nature, to relieve the important internal parts' of gouty irritation,
at the expense of the less important external parts. It also hap-
pens, because you have been treating a name instead of a con-
dition, — gout instead of gouty irritation. With the idea of irritation
before you, you would surely pause ere you proposed to cure that
which exists in the toes, by rousing a greater one in the viscera ;
but with the idea of mere gout, which may be anything you please,
you may give whatever you please to overcome great external
pain. For the rest, " it is as absurd," as Broussais well remarks,
** to speak of gout in the heady as it would be to talk of mania in

988 oooT.

ike loef ." Gout and ioBani^ aie conditions of tbe body, not men

▼ernacular terms.

All this is quite true, as every one can vouch who has been in
the habit of shortening fits of gout by colchicum : it is against
the intention of Nature, and no one who opposes her aims can hope
to succeed. In tbe treatment of gout by the water cure, on the
contrary, the irritative state being kept in view, and the object of
Nature appreciated, the means e<»isist of such as reduce internal
irritation on the one side, and of such as aid its removal to the ex-
ternal parts, on the other. The wet-sheet packing, and hot fo-
mentations to the abdomen, tend to the reduction of the visceral
irritation, and also assist, in some degree, in throwing it upon &o
external parts. This last office, however, is chiefly performed by
the sweating process, especially in one kind of gout, to which I
shall presently allude. Now as these various means aid the na-
tural efibrts so oflen referred to, a consequence of frequent occur-
rence in the water treatment of gout obtains, which, at first sight,
is disagreeable and discouraging enough. A patient coming to
be treated, but having no acute paroxysm of the disease at tUe
time, is^lmost sure to have one elicited, — ^perhaps one of the most
severe he ever had : and for this reason. The design of the water
treatment is to bring the internal irritation on the entire surface
of the skin, by sweat and other signals of skin excitement, so as
•o divert the visceral efibrts from the hands and feet. But these
last being the old points, towards which such efl^rts have been
long made (supposing it to be a long standing case), it is reasona-
ble enough to believe, that when the efforts are powerfully aided
by the appliances of the water treatment, they should still, fon a
time at least, be thrown upon those points, and with a vehemence
proportionate with the augmented impetus given to them by the
water cure. That this is the case would appear from the fact^
that the more recent the gouty disorder, and the less frequently,
therefore, the limbs have been the parts to receive the irritation
from within, the smaller is the chance of the water cure producing
a brisk attack of the disease, and the greater the facility of at
once transferring the mischief to the entire surface of the skin.

This, — ^the transference of the visceral irritation to the entire
skin — ^is the aim of cure in the treatment of gout by water. As
I have said, the wet-sheet packing and the sweating process are
the principal means of fulfilling it, Bui the relative applicabHity
of each can only be ascertained by reference to the species of

«oirr. SMO

gpai to be treated. There are two which are leading in their
characteristics, and should be signalized.

In one kind, which may be called the nervous or neuralgic form
of gouty the phenomena of inflamed mucous membrane, and dis-
eased mucous secretion of the digestive organs, are far from
being prominent : there is not much foulness nor yellowness of
tongue, although the thirst, heat of mouth and fbetor of breath
are there ; but the tongue is very red. Nervous headache of
intense degree precedes and attends the fit. The bowels are not '
constipated, neither is there any deficiency of bile in their excre-
tions, although that fluid be of a somewhat lighter color. The
kidneys give out large quantities of clear urine. The pulse is
very rapid, hard and sharp, and there is very frequently palpita-
tion of the heart. The general feverishness is great. As
regards the external parts, there is less swelling, but, if possible,
more heat and pain than in the other form : and the pain is not
continuously the same, but, without the smallest movement of the
limb, takes on sudden and extreme exasperation, and is traceable
for some distance up the leg or arm. There is no chalky secre-
tion in the joints. The complexion is clear. The attack comes
OD more rapidly, is preceded by more acute symptoms of dyspep-
sia, and hangs about for a longer period, being also more erratic
than the chalky gout now to be mentioned.

In chalky gout, the preliminary dyspeptic disturbance comes on
gradually, and is accompanied by more decided mucous disorder,
foul tongue, exceedingly foetid breath, extreme biliousness, acid
risings, &c. The head is more full, tight, and pulsative, than
acutely painful. The pulse is large, slow, hard, throbbing.
The bowels are very torpid and their excretion almost white.
The urine is scanty, foetid, and loaded with salts and mUcus.
The feverish heat is not acute. Externally, the inflamed joints
exhibit considerable swelling and* redness, but the pain is burning
and throbbing rather than darting, and it is continuously the
same. There is, besides, a still increasing deposit of chalky
idbumen in the joints, the secretion of which generally terminates
the attack more speedily and certainly than in the nervous form.
The inflammation also fixes upon, and remains in one or more
joints. Persons suffering from this form of gout are pale or
yellow in complexion, have waxy lips, and are more or less
. bloated in appearance.

Moh are the trenchant distinctions between two kinds of gouty

SMO G017T.

irritation which require difference of treatment. OccamonaHy,
these distinctions are seen in all their clearness : hut more fre« '
quently we meet with a commixture of the symptoms of hoth
kinds, a sliding of one into the other. And such it would appear
to be : the nervous kind being less intense than the chalky, which
last implies a more deteriorated condition of the blood than the
former. In nervous gout, there is irritation and loss of organic
energy in the nerves of digestion, sufficient to account for some
degree of diseased blood and still more for the mal-distribution of
it, so as to form congestions and inflammations about the organs
of digestion, the heart, head and limbs, and hence the unflxedness
of its attacks, and the changeableness of their seat, constituting
what has been called erratic gout ; hence, too, the rapidity of its
evolution, the internal parts not having as yet lost the capability .
of making a vehement effort to throw off their mischief. But
repeated attacks of this neuralgic gout, and repeated courses of
colchicum to get rid of them, gradually debilitate the organic
powers of the nerves of digestion, and increase the congestio
and oppression of its organs. Gradually, too, and as a consequeno»
of this, the blood-making process deteriorates, the circula'Ug
fluid becomes more diseased in its chemical and vital quallLes
ceases to redden the complexion, and pours out the morbid matters
with which it is loaded, by the kidneys, and, during the attacks,
into the sheaths of the joints, forming chalk stones. These results
of augmented digestive disorder, of more intense gouty irritation,
mark also diminished vital power in the internal organs to throw
off their mischief; and hence, the comparative slowness with
which the attack comes on, the long preliminary dyspepsia, the
fixation of the gout upon one or more often diseased, and greatly'
enfeebled joints, and the tediousness of the attack. Sometimes,
the organic power of the internal organs is so far deficient, as to
disable them from throwing out the gouty action at all. In that
case, the irritation accumulates within, threatening first one and
then another part, the heart, head, lungs, (Sec, and producing by
sympathy a host of uncomfortable symptoms, to which the name
of suppressed gout has been applied. Or if, with this incapacity
of the digestive parts to produce external gout, causes be at work
which involve the brain in unusual excitement, the gouty action
is transferred to that organ, e^nd gouty apoplexy, called gout in ihe
head, takes place. The like takes place if causes render the heart
the part most ready to receive the transfer, and spaem cfthe heart U

the fonn the gout takes : or asihrna supervenes upon its transfeir.
ence to the lungs : or, finally, the stomach itself takes on the
spasmodic action froni the excess of its. own gouty irrit^on and
incapability of evolving it.

But although the mingling of these two kinds of gouty action
be most frequently met with in practice, it behoves to hold them
well in view, when about to determine upon the treatment to be
adopted. It is necessary to ascertain the exact proportion be-
tween the neurdfgic and the purely gouty symptoms, to observe
which predominate, and to apply the processes of the water cure
accordingly. How this is to be done, will best appear after
briefly mentioning the applications to each kind of gout in its dC"
cided character as nervous or chalky.

Nervous or neuralgic gout implying a more acute disorder of
the digestive organs, being accompanied by fever of a more acute
character, indicating, in short, a state of excitement and exces-
sive action, the remedies of the water cure which tend to reduce
such action are clearly pointed out. In an attack, fomentations
of the abdomen, frequent wet-sheet packing, frequent change of
the abdominal compress, water drinking to the amount of eight
or nine tumblers daily, and reduction of diet to farinaceous
matters, are the best means ; damp compresses to the pained joints
being «dded. In the treatment for the chronic condition, the re-
medies should have the same direction, but need not, of course,
be so vigorously employed. Two wet sheets in the day, one be-
fore breakfast, the other at noon, or three hours after an early
dinner ; the sitz bath once or twice in the day : the abdominal
compress worn night and day : six, eight, or ten tumblers of water
in twenty-four hours : are the principal means. The diet best
adapted is the alternation of animal and vegetable food for dinner,
or even restriction of animal food to two days in the week : and the
vegetable taken should be confiped to farinaceous matters and
bread. The exercise should be as vigorous as the condition of
the limbs will allow : and, in the absence of sufficient power oh
their part, dry friction should be carried to a considerable extent.
If by these means the pulse be reduced in rapidity and irritability,
it is well to try the effect of the douche, beginning with a small
power and short time, and gradually extending both : but it is
necessary to watch the results of this application, lest it disturb
the nervous system too vehemently, and thus render the brain
liable to the gouty action. According to the organic capabilities
12

d4S AOUT. /

of the indiyidual, all the means mentioned should be increased i
two wet sheets in succession, for instance, beiru^ sujjstituted for
one, twice in the day. The result of this treatment is to reduce
the internal gouty irritation, thereby to improve the digestive pro-
cess, to cause better blood to be made to nourish the solids, which
thus gain the power of controlling its distribution. Critical action
takes place, but not necessarily in a vehement, concentrated form.
If the patient be fat or puffy, which is rarely the case in this
kind of gout, a few boils may form ; but a more frequent crisis
is a partial eruption of a kind very closely resembling red gall
{eczema impetiginodes), which inconveniences, by its mingled
burning and itching; for two or three weeks. A more frequent
crisis still, is that which slowly goes on in the course of altering the
mass of the circulating blood, and is often exhibited in occasional
relaxation of the bowels, large quantities of turbid urine, and a
continuous transpiration amounting sometimes to spontaneous
perspiration from the skin, of fluid of an acid or urinous odor.
All these, however, frequently stop for a time, and then return
with more vehemence.

Chalky gout implies a greater intensity of the gouty irritation,
with a more deteriorated, oppressed and obstructed condition of
the digestive organs, and notably of the liver. Not only is the
function of those parts obstructed, but, as a consequence of it,
we have a mass of circulating blood of a very diseased character
to deal with. The object of treatment, therefore, is to rouse the
internal functions and to quicken those vital and chemical changes
whereby the blood is made and wasted : so that whilst better blood
is being made, the former diseased mass may be got rid of. For
these purposes, it is necessary to employ the sweating process, the
douche, the prolonged shallow bath, the sitz bath, and copious
water drinking : as much exercise as possible aiding the whole.
The sweating may be practised daily, until headache and fever-
ishness announce that the body is becoming over-stimulated. The
same frequency and the same caution applies to the douche.
The object of the sitz bath is both to aid the action of the bowels,
and to prevent the over- stimulation alluded to. And the whole
of these external applications tend to bring to the entire surface
of the body a quantity of irritative action and blood, which would
otherwise be concentrated within, or thrown with painful vehe-
mence upon certain unlucky toes or fingers. -In all this, in the
lousing of the digestive functions, in giving a tendency towards

GOirr. 248

Ihe skip, and above all, in quickening the chemical changes of
the blood, the copious water drinking plays an indispensable and
important part. Having attention fixed on the head, it may be
carried to any extent, compatibly with the ease of that part. This
is, indeed, one of those instances in which the monstrous Grftefen-
berg doses of water are scarcely out of place ; the skin carrying
off no small portion of it in the daily sweats, and another con-
siderable portion passing through the kidneys, and carrying with
it gouty matters which would otherwise be retained in the circu-
lation to be thrown upon the limbs. As much exercise and air
as possible assist the alterative and detergent properties of the
processes recommended, and of the water drinking : and, as in
the previous instance, friction must be used, where active exertion
is not practicable. . If in the course of the treatment, feverishness
and hard sharp pulse come on, two or three days of wet-sheet
packing may be used to subdue it : but not unless the head be
full and painful, and the sleep prevented ; for some feverishness
precedes, and attends critical action in this malady, and in that
character need not be interfered with. Boils form the crisis of
this kind of gout, more frequently than of the other, the physical
condition of the patients being better adapted for their evolution.
But ill-smelling and glutinous sweats are, often enough, the only
external critical action exhibited ; urine loaded with salts and
mucus sometimes accompanying them. Bilious diarrhcea comes
on from time to time during the treatment, but rarely continues
long enough to make, per se, a decided impression on the gouty
diathesis and disease.

These indications of the mode in which the extremes of nerv-
ous and chalky gout should be managed, leave the treatment of
the form of disease partaking of both sufficiently obvious, and I
need not dwell upon it. Much, all indeed, depends upon the tact
of the physician in balancing the symptoms which demand the
ooothing, or the rousing of the internal functions, and the most
perspicuous and voluminous writing would fail to impart practical
acumen where it did not already exist.

And now comes the question, " Is gout curable by the water
treatment?" ^he answer of most writers on that treatment
has been in the loud and confident affirmative. I agree
with them, because the water plan is a natural one, and aids
Nature in her efforts ; and I believe that any plan which restricts
Us aim to this will, sooner or later, cure maladies that are not

j?44 ^ GOUT.

organic ; throughout the whole of this wOrk, that belief Is ao*
counted for. But the other question, " has gout been cur^ by
the water treatment, — cured in such way that it has not returned,
the ordinary causes of diet being avoided," cannot be answered
so confidently in the affirmative. Water cure books talk <^
<' perfect cures," and in very short spaces of time. But as I
desire to write to inform, not to deceive by exaggeration, I am
compelled to say that my experience offers no proof of such cures
in such time. In short, truth obliges me to state, that not one
case of gout has beep cured at Malvern, either in Dr. Wilson's
or my own practice. Acute attacks have been speedily got rid
of by the treatment, and with the great advantage of not damag-
ing but rather improving the viscera ; these attacks have be«Ei
rendered less frequent, weaker, shorter and rnore under com-
mand : the general health has been improved to a wonderful
degree, and in several instances, the life of patients has been
saved by rescuing the viscera from the gouty seiziire ; old chalky
concretions have been carried off, and the use of joints restored :
all this I have effected by applying the water cure to gout, and
it is much more than can be said for any other plan of treatment.
But to satisfy my mind as to the certainty of cure, the patient who
had previously been attacked two or three times a year, should
have passed eighteen or twenty-four months without any attaok
at all, his mode of life, meantime, being prudent in the matter of
diet, but not levelled to that of an invalid : he should, in short,
be able to pass the time mentioned without medical treatment and
without gout. With this definition of cure, I do not believe that
gout has been yet cured in this country, and I very much doubt
whether the histories imported from other countries, if so tested,
would be found correct. I have heard that Priessnitz himself
confesses, that he never cured but one case of gout, that is, ^radi-
cated the gouty diathesis. The fact is, that to do so requires
three, four, or five pexirs, not so many months, of assiduous wi^er
treatment, careful diet, and as much absence from naental care
as is attainable : and who are they who will afford this time,
attention and self-denial ?

It would be folly, however, to avoid a treatment because it will
not for ever root up your disease in your own convenient time.
Look at the destructive manner in which colchicum reduces a
gouty fit, how it approximates the attacks, and utterly disorganizes
the viscera : and then regard what the water cure is capable of

GOUT. 346

4oing, both against individual attacks, and in reduction of the
diathesis, the vital parts, meanwhile, improving under its opera-
tion ; — can there be a doubt of the reasonableness of adopting
the latter, both for the immediate and the ultimate purpose of
cure ? Life will thereby be rendered more tolerable and more
extended, and this is answer enough to the puerile question, that
many medical men have put regarding the use of the water treat-
ment : if it does not utterly cure the gout, at least it does not
shorten the patient's life, as col6hicum does.

Of the various instances of gout which have come before me,
I publish the following, as that in which the water treatment
. effected the greatest amount of benefit, and in a comparatively
short period of time :

Case XXVII. — ^Neevous Aim Chalky Gout.

This patient came to me in December, 1844. He had been the subject
of frequent gouty attacks for twenty years before, and was then in fais
fOTty-ninth year. The whole process described in the few last pages had
taken place in this instance, and under the auspices of colchicum the
paroxysms had become more and more frequent, until the patient passed
his life in almost one unceasing fit of gout. Withal, his joints had
become almost completely stiffened, those of the fingers containing sei^ial
chialk stones, whilst the ankle and toe joints admitted of no bending
whatever, and he walked on the flat of his foot. Between this pain and
sUffiiess of the joints, and the feebleness of the limbs generally, and of
the whole body, the smallest exertion had become nearly impossible.
When he came to me, he could not walk fifty yards, and then he lifted
the legs by means of the loins, and with infinite labor and slowness.
An ascent, however small, was altogether out of the question. His gene-
ral health, too, had been somewhat giving way of late, and he felt that
the colchicum was acting as a slow poison .on his frame. This conviction
had induced him some months before he saw me, to make trial of homoBo-
pathy, from which, however, he derived no benefit, partly, as it would
appear, from the unskilfulness of its application : so he had no alterna-
tive but the old poison, which he took up to the time of coming to
Malvem.

It did not appear that the gout in this case had been derived from a
paternal source. The patient himself was of opinion that he had acquired
it by his copious libations, of bad port when at Oxford. This fact, and
a singularly happy frame of mind, which never flagged in cheerfulness
even in the midst of acute pain, were favorable circumstances : whilst,
on the other hand, a lymphatic constitution, bloodless skin and lips, the
long continuance of the disease, and the prolonged use of poifloiKMi
ttedii^es, were opposed to the prospects of benefit

846 GOUT.

Aithoagh I have caJed this a case of '* nervous and chalky goat," the
latter character was fiiT predominant : the nervous character being only
exhibited during the intervals between bad attacks in the rapid passage
of pain from one point to another, without any fixed external signs, such
as swelling or redness, and also in frequently being confined to the
appearance of neuralgic pains along the whole course of the legs, arms
or loins. But in the regular paroxysms, all the phenomena were those
of chalky gout. The treatment therefore was principally, almost entirely,
of a kind to suit this last. The sweating process was employed from the
commencement, and, after some time) it was even used twice in the day,
a prolonged cold shallow bath succeeding it. The sitz bath was also
ordered for half an hour once a day. Cold wrung compresses were kept
in constant application to the feet, ankles and hands. The abdominal
compress was constantly worn, and the patient drank ten or twelve
tumblers of water in the day. The diet was of the plainest kind, and
including only three or four ounces of animal food once daily ; no warm
beverage was allowed. After a fortnight of this treatment the patient
was attacked with one of the most severe fits of gout he remembered
to have ever had. The pain was considerable, and for some days the
treatment was confined to tepid spongings of the body, hot fomentations
of the belly for an hour night and morning, frequent changes of the
compresses to the joints, very copious water drinking, and restriction of
diet to gruel and boiled rice. The fever attendant on the first outbreak
of the gout being, reduced, the sweating process was renewed twice -
a day, the fomentations were used at night, and all the other measures
were persisted in, the large water drinking especially. Nevertheless,
this attack travelled about from joint to joint, with alternations of ner-
vous pains in the loins, hips, shoulders and ribs, for nearly a month, so
powerfully had the water treatment aided the natural efibrts of the viscera
to throw off their irritation.

Out of this attack, the patient came with improved digestion and loco-
motive power ; a load seemed to have been taken from his system, and
although this had been the most severe of his fits, he expressed himself
delighted with the healthful sensations which succeeded it, compared
with those that had followed far shorter \nd much less painful fks in
which his old drug remedy was employed. In fact, this long and severe
fit and its subsequent sensations confirmed the patient's confidence in the
treatment, quite as much as if no such unpleasant commencement had
obtained, and, after a sojourn of seven weeks in Malvern, he went home,
with the resolution to continue some parts of the treatment there. He
did so, though not so continuously or vigorously as he had done here»
and had no gout during the two months he was away. Late in the spring
of 1845 he returned to Malvern, and went vigorously to work with sweat-
ing, douching, and sitz baths, with large doses of water, and considerable
exercise : for by this time he could walk miles instead of yards. In «
month, gout made another feeble attempt in the feet, but disappeared ui^

GOUT. 347

(or hovering for two days. Daring the three months he wts at
Malvern on this occasion, there was no other sign whatever of the mala-
dy : but on the other hand the restoration of the use of the limb was
altoirether astonishing. From being unable to walk a qnarter of a mile,
this patient's usual exercise before breakfast in the summer of last year
was to walk to the top of the Worcesfershire beacon, the highest of the
Malvern range, not by taking the cut zig-zag paths, but by ascending
straight on end ; and he descended in like manner. Looks and spirits
improved in the same proportion ; and his appetite was only too good, his
digestion excellent, and, as a consequence, his sleep sound.

During the first visit of this patient to Malvern, and for some period of
his second one, the skin gave evidence of critical action in the shape of
glntinoYj? sweat of a strongly urinous odor ; and this was secreted, not
only during the sweating process, but in the ordinary exhalations, and
was perceptible to those near him. It continued for three weeks to-
gether. No critical evacuation from the bowels took place : but invete-
rate constipation, of which he had for years been the victim, was com-
pletely overcome by his water treatment at Malvern.

Like all other Englishmen, this patient not having any compulsory o&-
cnpation, had created some, which, he thought, miLst be attended to : and
he left for his home in Surrey, in June, 1845. I had fears for his firm-
ness in continuing the treatment, and in avoiding the causes of his
malady. He was not cured, although he was in the high road to it, and
would still be cured with a couple of years of treatment The following
letter, however, shows how another fit of gout was thrown out by the
viscera, and it is very probable that several such would be elicited ere
the gouty disposition was exhausted. Between the former, and this at-
tack, however, a period of nearly nine months had intervened. It wUl
also be seen, that my fears about the patient's sufficient prudence were
not ill founded, as witness his " enjoyment with his friends." So that it
is no marvel that gout holds its ground to some extent still. Yet if ever
a case of gouty disorder was curable, this is it. The letter, dated in
January, 1846, reports thus :

^ I continued for some time nearly the same as when I left Malvern,
not making fast progress, nor yet standing still ; and thus I went on un-
til September, when the gout seemed determined to measure its strength
with all-powerful water. The attack was most spiteful, and I resisted
it manfully. It paid a visit to most of my joints except the knees. I
then went to Boulogne for a few days, and never felt better. Of course
I was somewhat weak in the understanding, but as to gout it was quite
gone. Occasionally, since then, I have felt little pains, and then it seems
as if each of these would have been an attack, for they come on in the
old way, but the fit seems spent before gout really ts^es place. (The
troth is, the visceral gouty irritation is so diminished as not to suffice for
a regular attack; with prudence, it woiild be altogether worn out)
I sweat eyery morning with the spirit lamp : the whole process aixt|

348 RHEUMATIC OOUT.

minutes, forty of which are of actual perspiratioD, during which, I drink
five large tumblers of water. I find I can now enjoy myself with my
friends as much as I could wish. I take wine only now and then, and
don't care if it be a pint or so. Indeed, Doctor, you have produced aU
you led me to expect, and I am very grateful for it. Life is to me quite
another thing : I can enjoy it, and instead of looking forward to an inva-
lid chair and crutches, I am the wonder of the neighborhood : and yet I
cannot persuade my invalid friends to go to Malvern : they tell me I
have a wonderful strong constitution, and all that nonsense (his constitu-
tion was utterly shattered when he came to Malvern). Now this I feel
more than anything, — that they should attribute to constitution, what is
entirely owing to your skill and learning. But say what I will, they
eeem determined to die in their ignorance— wilful ignorance: and
serve them right too," &c., &c.

If my patient would but become a teetotaler, he would never feel gout
again.

^Rhextmatic Gout.

The exposition of the nature and treatment of the maladies
which occupy the two preceding sections, renders any prolonged
account of rheumatic gout unnecessary. Partaking of the exter.
nal characteristics of both those diseases, it also acknowledges a
similar internal condition : there is the stomach and liver irrita-
tion, witli the general disorder of nutrition dependent on it. The
phase of visceral irritation, however, differs from that of ordinary
gout, inasmuch as it throws itself on any or all of the fibrous tis-
sues of the body, of the large as well as the small joints. It also
partakes more of the nervous than the chalky character of gout*
On the other hand, the rheumatic character is exhibited in the
fixation of pain in the large joints and fascise, in the extreme sen-
sitiveness of the body to barometric, thermometric, and electric
influences, and in the comparative frequency of the disease as an
accidental, and rarity as an hereditary infliction.

But the chief point to ascertain is, not what to designate the
disease, but what stage of visceral irritation is to be treated. As
I have said, the most usual is that which corresponds with ner-
Tous gout and neuralgic rheumatism. The difficulty of treating
such a combination, will be readily understood from what has
been said on each of those states. In fact, rheumatic gout is a
trial for the physician's skill and patience, as well as for the
patient's power of endurance. Sudden feverish attacks, thea
again symptoms indicative of obstructed rather than excessive

ftHEXniATIC GOUT. 240

ietion, incessant shifting of the seat of pain, and variety in its
character, render this one of the most tedious of diseases to bear
or to treat. However, the treatment must turn upon the fact of
obstruction or excessive action, the rules for which will be found
under the respective heads of rheumatism and gout. In the ma-
jority of cases, the wet-sheet packing is the principal remedy,
with an occasional and rare sweating. In other cases, again,
this proportion is reversed, and the wet sheet is used only from
time to time to keep down feverish excitement. In both sets of
cases, the douche is an important remedy, and is employed
either as a tonic, when the wet sheet has reduced the visceral
irritation, and lefl the body low, or as a stimulant in aid of the
sweating in its action of rousing obstructed and torpid functions.
Copious water drinking is necessary in all cases, except those
which exhibit a fulness of the head.

To be of permanent benefit, the water treatment of rheumatic
gout of long standing should be continued for at least fifteen,
eighteen or twenty-four months. In the course of my practice,
I have been enabled to bring considerable relief in several cases,
by lengthening the period between the attacks, and by shortening
the attacks themselves : but the treatment did not exceed three,
four and six months in duration, and was altogether inadequate
as curative of disease of seven, ten and twelve years' standing.
Still, I have not the least doubt that rheumatic gout is perfectly
curable by the water treatment, if time be given for it. Indeed,
one case I have cured, in which, from the recent date of the dis-
ease, and the youth of the patient, less time was required, and
sufficient time was afforded for the thorough operation of the
remedies. The patient was only thirty-two years old, and had
been afflicted only two years : so that by the brisk and persever-
ing action of the treatment during nearly five months on a tole-
rably good constitution, the pains disappeared altogether, and he
left Malvern having an understanding with me that if they re-
turned, he was to inform me. It is now eighteen months since
that time, and I have heard nothing of the patient or his com-
plaints. With time I would readily promise cure in much worse
I than this.

12*

850 DISEASES OF THE COLON —

CHAPTER V.

DISEASES OF THE LOWER ORGANS OF DIGESTION— DISEASES
OF EXCRETORY ORGANS.

Uses of excretory organs — ^Erroneous ideas concerQing constipation — ^Actual
function of the lower bowel — Rationale of excretion — Dependence of
constipation on the nervous and circulating systems — Constipation with
sufficient and with insufficient blood in the body — Its treatment accord-
ing to the presence or want of bloibd — Different kinds of Piles— -A symp-

. tomatic disorder— Connection with obstruction of liver, heart, and other
organs — Constipation as a cause — ^Danger of operations for piles — Treat-
ment — Mode of origin of functional Dropsy — Action of the kidneys in
it — Absurdity of diuretics — True aim of treatment — Pathology of skin
diseases, acute and chronic— Rationale of their outbreak and suppression
— Treatment.

Commencing with the diseases which assail the bipod-making
organs, the stomach and lungs, we have spoken of those of the
heart which circulates the blood, of the nervous system which
regulates its circulation, and of the limbs which are commanded
by the nervous system. It remains to speak of the morbid states
which obtain in certain organs, whose function, as regards the nu-
trition of the body, is rather negative than positive. They assist
in the maintenance of the body by eliminating from it mattera
which, if retained in the circulating mass of blood, would deteri-
orate its power of directly nourishing the various organs in a
healthy manner. Thus, the retention in the blood of the elemema
which form the faces, the urine, the sensible and insensible perspi-
ration, gives rise to the most formidable as well as the most tedi-
ous maladies : formidable in their acute, and sometimes in their
chronic form, in which latter they are always more or less tedious.
It is scarcely necessary to add, that the organs which carry on
these functions are the colon or lower bowel, the rectum, the kid-
neys i and the skin. As in the case of other organs and functions,
I shall only speak of thcfse which I have treated by the appliances
of the water cure.

CONSTirAiI«.!f. S51

§ 1. Dl^ASES OF THE CoLON — CoNSTIPATIOIf .

On no subject of medical concern is there more misconception
and prejudice among the laity, than on that of the depuratory of-
fice of the bowels. And no wonder : withih the first twenty-four
hours of mundane existence an aperient drug is introduced into
the digestive canal, and that irritative action, thus commenced, is
looked on as necessary to the well-being of the individual, . by
those whose office it is to watch over his younger years. By the
time he has reached the years of self-gu Idance, the same neces-
sity is impressed on his own mind, both fr m the mental habit, and
from the organic craving of the lower b wel itself, for the daily
or weekly excitation of the aperient : — a craving which induces
a sympathetic one in the brain, which vnll not be satisfied until
the old irritant is applied to the old spot. No matter how perfect-
ly well the persoO may be, appetite, sleep, spirits, walking power,
in the best order, no pain or ache present, no sense of fulness of
the bowels : yet he is haunted by this vision of constipated bow-
els : all must go wrong, if all be not already wrong, unless his
bowels are relieved : they were open yesterday, the day before,
and for a year past, but not having been open on this precise day,
the worst nuist happen. How hard, all but impossible, it is to
drive into the understanding of patients that all this is error, every
medical man of physiologica] education can say. It would seem
as if people lived to have stools and not had stools to live. These
last seem, with large classes of English society, to be the alpha
and omega of earthly existence, the one thing of never fading in-
terest, the much loved object of daily and hourly solicitude : all
the gigantic efforts of the reasoning faculty, all the empyrean
flights of the imaginative faculty are postponed for the elevating
function of evacuating the bowels !

It is s€ui folly, all this anxiety about the bowels : and much of
it is at the door of the patient who has grown up in it. But the
fault is also shared by great numbers of the lower class of medi-
cal men, called surgeon apothecaries, who either db not know the
physiological merits of the subject, and act in ignorance, or else
are too indolent steadily to resist the patient's prejudice for the
patient's good. These, the ordinary attendants of so many fami-
lies, might do much to abolish this pestilent and intolerably stupid
habit and prejudice of purgirlg the bowels, — ^the parent of so many
diseases which shorten life, and of so many more which render

DISEASES or THK COLON —

life scarce worth having. To the non-professiona readers of this
work / will, at least, offer some explanations conc€:-ning the office
of the colon, which will show them the uselessness and harmful,
ness of interfering with it, and also how the natural^ unforced ac-
tion of the howels Is the only one which is not harmful to the
body.

After being formed out of the food by the offices of the stomach
and lungs, the blood is passec on to the minutest blood-vessels of
all the tissues of the body. In these vessels, the great function?
of nutrition and secretiori are carried on : nutrition depositing the
solid parts and secreti a the liquid and gaseous. But all the
solids and the greater number of the liquids are only deposited
from the blood for a time : their status quo is most transitory.
The solids are broken down, and, by the absorption of the veins,
again carried into the torrent of the circulating blood. The same
takes place with regard to the liquid and gaseous deposits from
the blood. Every particle of brain, bone, muscle, sinew, &c., is
reliquified : and almost every drop of mucus, saliva, halitus, bile,
&c., is re-absorbed, and re-circulated. The chemical elements
of all the solid deposits and of all the secretions are therefore in
the blood.

Now there are certain of these secretions, which exist for the
purpose of carrying off from the circulating blood chemical com-
pounds derived from the breaking down and reliquifaction of the
solids of the body. Those compounds are called nitrogenizedy
nitrogen being the element they chiefly contain. The elimination
in question is effected in the kidneys by the secretion of urine,
and in a portion of the colon hy the secretion of the stools.

The object which nature has in the secretion of the stools is,
therefore, to rid her circulating blood of matters which, being no
longer of use for the purposes of nutrition of that body, would in-
terfere with it, if retained in the blood.

This is so true, that there are instances in which the colon
failing to secrete the faeces, the skin has been made the point of
elimination to a most disgusting extent. I have myself seen
several persons in whom the exhalation from the skin had a strong
fseca^ odor from this cause. Moreover, any one in ordinary
health may observe, that when, from any cause, a smaller quan-
tity of stools than usual is secreted, a larger quantity of urine is
passed, and vice versa, nature ridding the blood by one channel
when the other fails.

CONSTIPATION. 858'

The fseces, then, are to be regarded as a secretion from the
mucous membrane of the colon, just as gastric juice is a secretion
• from the same membrane of the stomach, the tears from the mu-
cous membrane of the lachrymal glands, the wax from that mem-
brane of the outer ear, &c. In short, their production is exactly
similar to that of any other secreted matter of the body ; but inas-
much as they are secreted for the purpose of being thrown out of
the body, they are called an excretion more commonly than a
secretion. Here I would remark, as I have done in several
places before, on the mischief of dealing with names instead of
acts. Because stools are called excrements, people get it into
their heads that it is always there, in the bowels, to be passed oflfj
and must be passed off, without the slightest reference to the other
effects of the means they use for hastening the excretion, and
without asking themselves the very simple question, " whence
come all these faeces V* Yet it is one which, properly answered,
would have prevented many a mortal malady, and saved a world
of mental and bodily suffering to tlio crowds of colocynth eaters
that are to be found in England.

" Whence come the faeces ?" Unquestionably from the same
source as all the other secretions of the body— ^from the blood ;
from the blood which circulates in the mucous lining of the colon.
Sometimes there are portions of undigested or indigestible food,
such as the skins of fruits, and the husk of oatmeal, mixed up
with them, having been untouched by the gastric juice: but
these are adventitious, and not an essential part of the stools.
These last, therefore, being secreted from the blood, must derive
their quantity and quality from the quatntity and quality of the
blood at the time distributed in the lining of the colon.

But as this blood circulates in blood-vessels which owe their
vital irritability to the ganglionic nervous matter (see page 4),
with which they are supplied, it follows that the faecal secretion
also depends upon the condition of the nervous matter in ques-
tion. As in the other secretions of the frame, the first influence
of causes is upon the ganglionic nervous matter, which then alters
the contractile action of the blood-vessels of the colon, this, again,
altering the quantity of blood in that part, and the consequent
secretions from it.

Thus we see that the secreting action of the colon depends upon
the quantiiy of blood in its vessels, and the quality of the nervous
^ency operating upon them.

•854 DISEASES or the colon —

Now suppose that a man has a large quantity of good blood io
his whole body, there will be amply sufficient for the purposes of
secretion in all parts of that body, — for the faeces among the rest.
Such a man ought to have liis bowels evacuated once in twenty.
four or thirty-six hours, of between five and six ounces of fseces,
and he will have them so evacuated if he takes sufficient exercise,
does not sleep too long, avoids irritating articles of diet, keeps out
mental care and overtoil ; if, in short, he maintains his ganglionic
nervous system in order. For remark, that when he does not
exercise his will in bodily exertion, when his brain sleeps toe
long, or, on the other hand, when it is overworked, excess and
congestion of blood take place in it, and the distribution of blood
is rendered unequal throughout the ganglionic nervous system :
— the brain itself representing a very important part of that sys-
tem (see page 4). The consequence is that blood being plus in
the brain and spinal cord, is minus in the mucous and nervous
tissues of the colon ; the secretory power of that bowel is there-
fore impaired ; and the patient is consUpaied,

Suppose the same full-blooded person to eat and drink impro-
per things, the same process of congestion of blood takes place in
the mucous membrane and nerves of the stomach which took
place in the brain in the other case, with the addition, very com-
monly, of the brain congestion as well ; the distribution of blood
is changed, to the detriment of the colon ; and the patient is consU-
paied,

The causes originating in the brain, and those which begin m
the stomach, which. I have just mentioned, are the ordinary
causes of indigestion, apd thus it is that constipation forms an
almost invariable symptom of that malady in persons who are
well supplied with blood.

But why do the bowels become constipated in those who have
not sufficient blood in the body ? Simply, because they do not
possess enough of that precious liquid for the purposes of large
secretion. Nature cannot afford it. What little blood there is
in the frame she concentrates in the citadels of life, in the two
great ganglionic centres, in the brain and in the stomach, so thai
they, at least, may not want wherewithal to carry on the two
great functions of nutrition and sensation. She thus deprives the
outer skin of its blood and perspiration, and the inner excreting
skin of the colon of its blood and stools : and we find many a
lean, pale, dry-skinned individual also a costive one. If such m

GOUT. 245

tfoing, both against individual attacks, and in reduction of the
diathesis, the vital parts, meanwhile, improving under its opera-
lion ; — can there be a doubt of the reasonableness of adopting
the latter, both for the immediate and the ultimate purpose of
cure ? Life will thereby be rendered more tolerable and more
extended, and this is answer enough to the puerile question, that
many medical men have put regarding the use of the water treat-
ment : if it does not utterly cure the gout, at least it does not
shorten the patient's life, as col6hicum does.

Of the various instances of gout which have come before me,
I publish the following, as that in which the water treatment
. effected the greatest amount of benefit, and in a comparatively
short period of time :

Case XXVII. — ^Nervous and Chalky Gout.

This patient came to me in December, 1844. He had been the subject
of frequent gouty attacks for twenty years before, and was then in his
forty-ninth year. The whole process described in the few last pages had
taken place in this instance, and 'tinder the auspices of colchicum the
paroxysms had become more and more frequent, until the patient passed
his life in almost one unceasing jfit of gout. Withal, his joints had
become almost completely stiffened, those of the fingers containing seVeial
chalk stones, whilst the ankle and toe joints admitted of no bending
whatever, and he walked on the flat of his foot. Between this pain and
sUf&ess of the joints, and the feebleness of the limbs generally, and of
the whole body, the smallest exertion had become nearly impossible.
When he came to me, he could not walk fifty 3rards, and then he lifted
the legs by means of the loins, and with infinite labor and slowness.
An ascent, however small, was altogether out of the question. His gene-
ral health, too, had been somewhat giving way of late, and he felt that
the colchicum was acting as a slow poison on his frame. This conviction
had induced him some months before he saw me, to make trial of hemoso-
pathy, from which, however, he derived no benefit, partly, as it would
appear, from the unskilfulness of its application : so he had no alterna-
tive but the old poison, which he took up to the time of coming to
Malvern.

It did not appear that the gout in this case had been derived from a
paternal source. The patient himself was of opinion that he had acquired
it by his copious libations, of bad port when at Oxford. This fact, and
a singularly happy frame of mind, which never flagged in cheerfulness
even in the midst of acute pain, were favorable circumstances : whilst,
on the other hand, a lymphatic constitution, bloodless skin and lips, the
long continuance of the disease, and the prolonged use of poisoiKMS
mMtkudBf were opposed to the prospects of benefit

846 GOUT.

Aithoa^ I have caJed this a case of " nervous and chalky gont," tlie
latter character was £a,r predominant : the nervous character being only
exhibited during the intervals between bad attacks in the rapid passage
of pain from one point to another, without any fixed external signs, such
as swelling or redness, and also in frequently being confined to the
appearance of neuralgic pains along the whole course of the legs, arms
or loins. But in the regular paroxysms, all the phenomena were those
of chalky goat The treatment therefore was principally, almost entirely,
of a kind to suit this last The sweating process was employed from the
commencement, and, after some time^ it was even used twice in the day,
a prolonged cold shallow bath succeeding it The sitz bath was also
ordered for half an hour once a day. Cold wrung compresses were kept
in constant application to the feet, ankles and hands. The abdominal
compress was constantly worn, and the patient drank ten or twelve
tumblers of water in the day. The diet was of the plainest kind, and
including only three or four ounces of animal food once daily ; no warm
beverage was allowed. After a fortnight of this treatment the patient
was attacked with one of the most severe fits of gout he remembered
to have ever had. The pain was considerable, and for some days the
treatment was confined to tepid spongings of the body, hot fomentations
of the belly for an hour night and morning, frequent changes of the
compresses to the joints, very copious water drinking, and restriction of
diet to gruel and boiled rice. The fever attendant on the first outbreak
of the gout being, reduced, the sweating process was renewed twice
a day, the fomentations were used at night, and all the other measures
were persisted in, the large water drinking especially. Nevertheless,
this attack travelled about from joint to joint, with alternations of ner-
vous pains in the loins, hips, shoulders and ribs, for nearly a month, so
powerfully had the water treatment aided the natural efforts of the viscera
to throw off their irritation.

Out of this attack, the patient came with improved digestion and loco-
motive power ; a load seemed to have been taken from his system, and
although this had been the most severe of his fits, he expressed himself
delighted with the healthful sensations which succeeded it, compared
with those that had followed far shorter \nd much less painful fits in
which his old drug remedy was employed. In fact, this long and severe
fit and its subsequent sensations confirmed the patient's confidence in the
treatment, quite as much as if no such unpleasant commencement had
obtained, and, after a sojourn of seven weeks in Malvern, he went home.,
with the resolution to continue some parts of the treatment there. He
did so, though not so continuously or vigorously as he had done herei
and had no gout during the two months he was away. Late in the spring
of 1845 he returned to Malvern, and went vigorously to work with sweat-
ing, douching, and sitz baths, with large doses of water, and considerable
exercise : for by this time he could walk miles instead of ya!rds. In ft
month, gout made another feeble attempt in the fieet, but disappeared ui^

GODT. 947

lor hov^Dg for two days. Daring the three months he wii at
Malvern on this occasion, there was no other sign whatever of the mala-
dy : but on the other hand the restoration of the use of the limb was
altoQ^ether astonishing. From being unable to walk a quarter of a mile,
this patient's usual exercise before breakfast in the summer of last year
was to walk to the top of the Worcestershire beacon, the highest of the
Malvern range, not by taking the cut zig-zag paths, but by ascending
straight on end ; and he descended in like manner. Looks and sjnrita
improved in the same proportion ; and his appetite was only too good, hia
digestion excellent, and, as a consequence, his sleep sound.

During the first visit of this patient to Malvern, and for some period of
his second one, the skin gave evidence of critical action in the shape of
glutinou? sweat of a strongly urinous odor ; and this was secreted, not
only during the sweating process, bat in the ordinary exhalations, and
was perceptible to those near him. It continued for three weeks to-
gether. No critical evacuation from the bowels took place : bat invete-
rate constipation, of which he had for years been the victim, was com-
pletely overcome by his water treatment at Malvern.

Like all other Englishmen, this patient not having any compulsory oc-
cupation, had created some, which, he thought, must be attended to : and
he left for his home in Surrey, in June, 1845. I had fears for his firm-
ness in continuing the treatment, and in avoiding the causes of his
malady. He was not cured, although he was in the high road to it, and
would still be cured with a couple of years of treatment. The following
letter, however, shows how another fit of gout was thrown out by the
viscera, and it is very probable that several such would be elicited ere
the gouty disposition was exhausted. Between the former, and this at-
tack, however, a period of nearly nine months had intervened. It will
also be seen, that my fears about the patient's sufficient prudence were
not iU founded, as witness his " enjoyment with his friends." So that it
is no marvel that gout holds its ground to some extent still. Yet if ever
a case of gouty disorder was curable, this is it. The letter, dated in
January, 1846, reports thus :

^ I continued for some time nearly the same as when I left Malvern,
not making fast progress, nor yet standing still ; and thus I went on un-
til September, when the gout seemed determined to measure its strength
with all-powerful water. The attack was most spiteful, and I resisted
it manfully. It paid a visit to most of my joints except the knees. I
then went to Boulogne for a few days, and never felt better. Of course
I was somewhat weak in the understanding, but as to gout it was quite
gone. Occasionally, since then, I have felt little pains, and then it seems
as if each of these would have been an attack, for they come on in the
old way, but the fit seems spent before gout really takes place. (The
troth is, the msceral gouty irritation is so diminished as not to sufiice for
a regular attack; with prudence, it woiild be altogether worn oat)
I sweat eyery morning with the spirit lamp : the whole process rizty

948 EHEUMATIC GOUT.

minutes, forty of which are of actual perspiratioD, during which, I drink
five large tomhlers of water. I find I can now enjoy myself with my
friends as much as I could wish. I take wine only now and then, and
don't care if it be a pint or so. Indeed, Doctor, you have produced all
you led me to expect, and I am very grateful for it. Life is to me quite
another thing : I can enjoy it, and instead of looking forward to an inva-
lid chair and crutches, I am the wonder of the neighborhood : and yet I
cannot persuade my invalid friends to go to Malvern : they tell me I
have a wonderful strong constitution, and all that nonsense (his constitu-
tion was utterly shattered when he came to Malvern). Now this I feel
more than anything, — that they should attribute to constitution, what is
entirely owing to your skill and learning. But say what I will, they
seem determined to die in their ignorance— wilful ignorance: and
serve them right too," dtc, &c.

If my patient would but become a teetotaler, he would never feel gout
again.

§ Rheumatic Gout.

The exposition of the nature and treatment of the maladies
which occupy the two preceding sections, renders any prolonged
account of rheumatic goiU unnecessary. Partaking of the exter-
nal characteristics of both those diseases, it also acknowledges a
similar internal condition : there is the stomach and liver irrita-
tion, with the general disorder of nutrition dependent on it. The
phase of visceral irritation, however, differs from that of ordinary
gout, inasmuch as it throws itself on any or all of the fibrous tis-
sues of the body, of the large as well as the small joints. It also
partakes more of the nervous than the chalky character of gout*
On the other hand, the rheumatic character is exhibited in the
fixation of pain in the large joints and fasciae, in the extreme sen-
sitiveness of the body to barometric, thermometric, and electric
influences, and in the comparative frequency of the disease as an
accidental, and rarity as an hereditary infliction.

But the chief point to ascertain is, not what to designate the
disease, but what stage of visceral irritation is to be treated. As
I have said, the most usual is that which corresponds with ner-
Tous gout and neuralgic rheumatism. The difficulty of treating
such a combination, will be readily understood from what has
been said on each of those states. In fact, rheumatic gout is a
trial for the physician's skill and patience, as well as for the
patient's power of endurance. Sudden feverish attacks, theu
•gain symptoms indicative of obstructed rather than excessive

HHEirUJLTIC 6017T. 249

Action, inceasaDt shifting of the seat of pain, and variety in its
character, render this one of the most tedious of diseases to hear
or to treat. However, the treatment must turn upon the fact of
obstruction or excessive action, the rules for which will be found
under the respective heads of rheumatism and gout. In the ma«
jority of cases, the wet-sheet packing is the principal remedy,
with an occasional and rare sweating. In other cases, again,
this proportion is reversed, and the wet sheet is used only from
time to time to keep down feverish excitement. In both sets of
cases, the douche is an important remedy, and is employed
either as a tonic, when the wet sheet has reduced the visceral
irritation, and lefl the body low, or as a stimulant in aid of the
sweating in its action of rousing obstructed and torpid functions.
Copious water drinking is necessary in all cases, except those
which exhibit a fulness of the head.

To be of permanent benefit, the water treatment of rheumatic
gout of long standing should be continued for at least fifteen,
eighteen or twenty-four months. In the course of my practice,
I have been enabled to bring considerable relief in several cases,
by lengthening the period between the attacks, and by shortening
the attacks themselves : but the treatment did not exceed three^
four and six months in duration, and was altogether inadequate
as curative of disease of seven, ten and twelve years' standing.
Still, I have not the least doubt that rheumatic gout is perfectly
curable by the water treatment, if time be given for it. Indeed,
one case I have cured, in which, from the recent date of the dis-
ease, and the youth of the patient, less time was required, and
sufficient time was afforded for the thorough operation of the
remedies. The patient was only thirty-two years old, and had
been afflicted only two years : so that by the brisk and persever-
ing action of the treatment during nearly five months on a tole-
rably good constitution, the pains disappeared altogether, and he
left Malvern having an understanding with me that if they re-
turned, he was to inform me. It is now eighteen months since
that time, and I have heard nothing of the patient or his com-
plaints. With time I would readily promise cure in much worse
cases than this.

12*

850 DISEASES OF THE COI<ON —

CHAPTER V.

DISEASES OF THE LOWER ORGANS OF DIGESTION— DISEASES
OF EXCRETORY ORGANS.

Uses of excretory organs — ^Erroneous ideas concerning constipation-— Actual
function of the lower bowel — Rationale of excretion — Dependence of
constipation on the nervous and circulating systems — Constipation with
sufficient and with insufficient blood in the body — Its treatment accord-
ing to the presence or want of blood — Different kinds of Piles— ^A symp-

. tomatic disorder—Connection with obstruction of liver, heart, and other
organs — Constipation as a cause — Danger of operations for piles — Treat-
ment — Mode of origin of functional Dropsy — Action of the kidneys in
it — Absurdity of diuretics — True aim of treatment — Pathology of skin
diseases, acute and chronic—Rationale of their outbreak and suppression
— Treatment

Commencing with the diseases which assail the b^pod-making
organs, the stomach and lungs, we have spoken of those of the
heart which circulates the blood, of the nervous system which
regulates its circulation, and of the limbs which are commanded
by the nervous system. It remains to speak of the morbid states
which obtain in certain organs, whose function, as regards the nu-
trition of the body, is rather negative than positive. They assist
in the maintenance of the body by eliminating from it matters
which, if retained in the circulating mass of blood, would deteri-
orate its power of directly nourishing the various organs in a
healthy manner. Thus, the retention in the blood of the elemema
which form the ftBces, the unne, the sensible and insensible persjn-
ration, gives rise to the most formidable as well as the most tedi-
ous maladies : formidable, in their acute, and sometimes in their
chronic form, in which latter they are always more or less tedious.
It is'^scarcely necessary to add, that the organs which carry on
these functions are the colon or lower bowel, the rectum^ the kid-
neyji and the skin. As in the case of other organs and functions,
I shall only speak of those which I have treated by the applianoea
of the water cure.

CONSTlPAiKJI. 951

§ 1. Dlsbases of the Colon — Constipatiom.

Oa no subject of medical concern is there more misoonception
and prejudice among the laity, than on that of the depuratory of>
fice of the bowels. And no wonder : withib the first twenty-four
hours of mundane existence an aperient drug is introduced into
the digestive canal, and that irritative action, thus commenced, is
looked on as necessary to the well-being of the individual, . by
those whose office it is to watch over his younger years. By the
time he has reached the years of self-gu idance, the same neces-
sity is impressed on his own mind, both ft m the mental habit, and
from the organic craving of the lower b we\ itself, for the daily
or weekly excitation of the aperient : — a craving which induces
a sympathetic one in the brain, which toill not be satisfied until
the old irritant is applied to the old spot. No m£^tter how perfect-
ly well the person may be, appetite, sleep, spirits, walking power,
in the best order, no pain or ache present, no sense of fulness of
the bowels : yet he is haunted by this vision of constipated bow-
els : all must go wrong, if all be not already wrong, unless his
bowels are relieved : they were open yesterday, the day before,
and for a year past, but not having been open on this precise day,
the worst must happen. How hard, all but impossible, it is to
drive into the understanding of patients that all this is error, every
medical man of physiological education can say. It would seem
as if people lived to have stools and not had stools to live. These
last seem, with large classes of English society, to be the alpha
and omega of earthly existence, the one thing of never fading in-
terest, the much loved object of daily and hourly solicitude : all
the gigantic efforts of the reasoning faculty, all the empyrean
flights of the imaginative faculty are postponed for the elevating
function of evacuating the bowels !

It is sad folly, all this anxiety about the bowels : and much of
it is at the door of the patient who has grown up in it. But the
fault is also shared by great numbers of the lower class of medi-
cal men, called surgeon apothecaries, who either do not know the
physiological merits of the subject, and act in ignorance, or else
are too indolent steadily to resist the patient's prejudice for the
patient's good. These, the ordinary atteQdants of so many fami-
lies, might do much to abolish this pestilent and intolerably stupid
habit and prejudice of purgirig the bowels, — ^the parent of so many
diseases which shorten life, and of so many more which render

-^te DISEASES OF THK COLON —

life scarce worth having. To the non-professiona readers of this
work / will, at least, offer some explanations conc€:ning the office
of the colon, which will show them the uselessness and harmful-,
ness of interfering with it, and also how the natural, unforced ac-
tion of the bowels is the only one which is not harmful to the
l)ody.

After being formed out of the food by the offices of the stomach
and lungs, the blood is passec on to the minutest blood-vessels of
all the tissues of the body. In these vessels, the great functions
of nutrition and secretion are carried on: nuiriiion depositing, the
solid parts and secreii n the liquid and gaseous. But all the
solids and the greater number of the liquids are only deposited
from the blood for a time : their stoUus quo is most transitory.
The solids are broken down, and, by the absorption of the veins,
again carried into the torrent of the circulating blood. The same
lakes place with regard to the liquid and gaseous deposits from
the blood. Every particle of brain, bone, muscle, sinew, &c., is
reliquified : and almost every drop of mucus, saliva, halitus, bile,
&c., is re-absorbed, and re-circulated. The chemical elements
of all the solid deposits and of all the secretions are therefore in
the blood.

Now there are certain of these secretions, which exist for the
purpose of carrying off from the circulating blood chemical com-
pounds derived from the breaking down and reliquifaction of the
solids of the body. Those compounds are called nitrogenized,
nitrogen being the element they chiefly contain. The elimination
in question is effected in the kidneys by the secretion of urine,
and in a portion of the colon by the secretion of the stools.

The object which nature has in the secretion of the stools is,
therefore, to rid her circulating blood of matters which, being no
longer of use for the purposes of nutrition of that body, would in-
terfere with it, if retained in the blood.

This is so true, that there are instances in which the colon
failing to secrete the fseces, the skin has been made the point of
elimination to a most disgusting extent. I have myself seen
several persons in whom the exhalation from the skin had a strong
fsecal odor from this cause. Moreover, any one in ordinary
health may observe, that when, from any cause, a smaller quan-
tity of stools than usual is secreted, a larger quantity of urine is
passed, and vice versa, nature ridding the blood by one chanoel
when the other fails.

CONSTIPATION. 258'

The fscesy then, are to be regarded as a secretion from the
mucous membrane of the colon, just as gastric juice is a secretion
• from the same membrane of the stomach, the tears from the mu-
cous membrane of the lachrymal glands, the wax from that mem-
brane of the outer ear, &c. In short, their production is exactly
similar to that of any other secreted matter of the body ; but inas-
much as they are secreted for the purpose of being thrown out of
the body, they are called an excretion more commonly than a
secretion. Here I would remark, as I have done in several
places before, on the mischief of dealing with najnes instead of
acts. Because stools are called excrements, people get it into
their heads that it is always there, in the bowels, to be passed oflfj
and must be passed off, without the slightest reference to the other
effects of the means they use for hastening the excretion, and
without asking themselves the very simple question, " whence
come all these faeces ?" Yet it is one which, properly answered,
would have prevented many a mortal malady, and saved a world
of mental and bodily suffering to the crowds of colocynth eaters
that are to be found in England.

" Whence come the faeces ?" Unquestionably from the same
source as all the other secretions of the body— jfrom the blood ;
from the blood which circulates in the mucous lining of the colon.
Sometimes there are portions of undigested or indigestible food,
such as the skins of fruits, and the husk of oatmeal, mixed up
with them, having been untouched by the gastric juice : but
these are adventitious, and not an essential part of the stools.
These last, therefore, being secreted from the blood, must derive
their quantity and quality from the quemtity and quality of the
blood at the time distributed in the lining of the colon.

But as this blood circulates in blood-vessels which owe their
vital irritability to the ganglionic nervous matter (see page 4),
with which they are supplied, it follows that the faecal secretion
also depends upon the condition of the nervous matter in ques-
tion. As in the other secretions of the frame, the first influence
of causes is upon the ganglionic nervous matter, which then altera
the contractile action of the blood-vessels of the colon, this, again,
altering the quantity of blood in that part, and the consequent
secretions from it.

Thus we see that the secreting action of the colon depends upon
Ihe quantity of blood in its vessels^ and the quality of the nervoui
Qgency operating upon them.

mL4 ^ GOUT.

organic ; throughout the whole of this work, that belief is aa*
Qounted for. But the other question, " has gout been cured by
the water treatment, — cured in such way that it has not returned,
the ordinary causes of diet being avoided," cannot be answeir€4
so confidently in the affirmative. Water cure books talk of
" perfect cures," and in very short spaces of time. But as I
desire to write to inform, not to deceive by exaggeration, I am
compelled to say that my experience offers no proof of such cures
in such time. In short, truth obliges me to state, that not one
case of gout has been cured at Malvern, either in Dr. Wilson's
or my own practice. Acute attacks have been speedily got rid
of by the treatment, and with the great advantage of not damage
ing but rather improving the viscera ; these attacks have beea
rendered less frequent, weaker, shorter and niore Under com^
mand ; the general health has been improved to a wonderful
degree, and in several instances, the life of patients has b^n
saved by rescuing the viscera from the gouty seizure ; old chalky
concretions have been carried off, and the use of joints restored :
all this I have effected by applying the water cure to gout, and
it is much more than can be said for any other plan of treatment.
But to satisfy my mind as to the certainty of curCi the patient who
had previously been attacked two or three times a year, dhould
have passed eighteen or twenty-four months without any attaok
at all, his mode of life, meantime, being prudent in the matter of
diet, but not levelled to that of an invalid : he should, in short,
be able to pass the time mentioned without medical treatment and
without gout. With this definition of cure, I do not believe that
gout has been yet cured in this country, and I very much doubt
whether the histories imported from other countries, if so tested,
would be found correct. I have heard that Priessnitz himself
confesses, that he never cured but one case of gout, that is, ^radi-
cated the gouty diathesis. The fact is, that to do so requires
three, four, or five ye^rs, not so many months, of assiduous water
treatment, careful diet, and as much absence from mental care
as is attainable : and who are they who will afford this tinoe,
attention and self-denial ?

It would be folly, however, to avoid a treatment because it will
not for ever root up your disease in your own convenient tira^.
Look at the destructive manner in which colchicum reduces a
gouty fit, how it approximates the attacks, and utterly disorganize!!
the viscera : and then regard what the water cure it capable of

GOUT. 245

iloing, both against individual attacks, and in reduction of the
diathesis, the vital parts, meanwhile, improving under its opera-
tion ;— can there he a doubt of the reasonableness of adopting
the latter, both for the immediate and the ultimate purpose of
cure ? Life will thereby be rendered more tolerable and more
extended, and this is answer enough to the puerile question, that
many medical men have put regarding the use of the water treat-
ment : if it does not utterly cure the gout, at least it does not
shorten the patient's life, as col6hicum does.

Of the various instances of gout which have come before me,
I publish the following, as that in which the water treatment
effected the greatest amount of benefit, and in a comparatively
short period of time :

Case XXVII. — ^Nervous and Chalky Gout.

This patient came to me in December, 1844. He had been the subject
of frequent gouty attacks for twenty years before, and was then in his
forty-ninth year. The whole process described in the few last pages had
taken place in this instance, and under the auspices of colchicum the
paroxysms had become more and more frequent, until the patient passed
his life in almost one unceasing fit of gout. Withal, his joints had
become almost completely stifiened, those of the fingers containing seVeial
chalk stones, whilst the ankle and toe joints admitted of no bending
whatever, and he walked on the flat of his foot. Between this pain and
Btiffiiess of the jomts, and the feebleness of the limbs generally, and of
the whole body, the smallest exertion had become nearly impossible.
When he came to me, he could not walk fifty yards, and then he lifted
the legs by means of the loins, and with infinite labor and slowness.
An ascent, however small, was altogether out of the question. His gene-
ral health, too, had been somewhat giving way of late, and he felt that
the colchicum was acting as a slow poison on his frame. This conviction
had induced him some months before he saw me, to make trial of hemoso-
pathy, from which, however, he derived no benefit, partly, as it would
appear, from the unskilfulness of its application : so he had no alterna-
tive but the old poison, which he took up to the time of coming to
Malvem.

It did not appear that the gout in this case had been derived from a
paternal source. The patient himself was of opinion that he had acquired
it by his copious libations, of bad port when at Oxford. This fact, and
a singularly happy frame of mind, which never flagged in cheerfulness
even in the midst of acute pain, were favorable circumstances : whilst,
on the other hand, a lymphatic constitution, bloodless skin and lips, the
long continuance of the disease, and the prolonged use of poiaoiKNUi
vetfieiiieB, were opposed to the prospects of benefit

S46 GOUT.

Although I have caJed this a case of " nervous and chalky gout," tlie
latter character was far predominant : the nervous character being only
exhibited during the intervals between bad attacks in the rapid passage
of pain from one point to another, without any fixed external signs, such
as swelling or redness, and also in frequently being confined to the
appearance of neuralgic pains along the whole course of the legs, arms
or loins. But in the regular paroxysms, all the phenomena were those
of chalky gout The treatment therefore was principally, almost entirely,
of a kind to suit this last. The sweating process was employed from the
commencement, and, after some time^ it was even used twice in the day,
a prolonged cold shallow bath succeeding it. The sitz bath was also
ordered for half an hour once a day. Cold wrung compresses were kept
in constant application to the feet, ankles and hands. The abdominal
compress was constantly worn, and the patient drank ten or twelve
tumblers of water in the day. The diet was of the plainest kind, and
including only three or four ounces of animal food once daily ; no warm
beverage was allowed. After a fortnight of this treatment the patient
was attacked with one of the most severe fits of gout he remembered
to have ever had. The pain was considerable, and for some days the
treatment was confined to tepid spongings of the body, hot fomentations
of the belly for an hour night and morning, frequent changes of the
compresses to the joints, very copious water drinking, and restriction of
diet to gruel and boiled rice. The fever attendant on the first outbreak
of the gout being, reduced, the sweating process was renewed twice
a day, the fomentations were used at night, and all the other measures
were persisted in, the large water drinking especially. Nevertheless,
this attack travelled about from joint to joint, with alteniations of ner-
vous pains in the loins, hips, shoulders and ribs, for nearly a month, so
powerfully had the water treatment aided the natural efibrts of the viscera
to throw off their irritation.

Out of this attack, the patient came with improved digestion and loco-
motive power ; a load seemed to have been taken from his system, and
although this had been the most severe of his fits, he expressed himself
delighted with the healthful sensations which succeeded it, compared
with those that had followed far shorter \nd much less painful fits in
which his old drug remedy was employed. In fact, this long and severe
fit and its subsequent sensations confirmed the patient's confidence in the
treatment, quite as much as if no such unpleasant commencement had
obtained, and, after a sojourn of seven weeks in Malvern, he went home,
with the resolution to continue some parts of the treatment there. He
did so, though not so continuously or vigorously as he had done here?
and had no gout during the two months he was away. Late in the spring
of 1845 he returned to Malvern, and went vigorously to work with sweat-
ing, douching, and sitz baths, with large doses of water, and considerable
exercise : for by this time he could walk miles instead of yairds. In ft
month, gout made another feeble attempt in the feet, but disappeaied ui^

GODT. 847

ler hov^ing for two days. Daring the three months he wii at
Malvern on this occasion, there was no other sign whatever of the mala-
dy : but on the other hand the restoration of the use of the limb was
altoiTether astonishing. From being unable to walk a quarter of a mile,
this patient's usual exercise before breakfast in the summer of last year
was to walk to the top of the Worcesfershire beacon, the highest of the
Malvern range, not by taking the cut zig-zag paths, but by aacending
straight on end ; and he descended in hke manner. Looks and sinrita
improved in the same proportion ; and his appetite was only too good, hia
digestion excellent, and, as a consequence, his sleep sound.

Daring the first visit of this patient to Malvern, and for some period of
his second one, the skin gave evidence of critical action in the shape of
glutinoii? sweat of a strongly urinous odor ; and this was secreted, not
only during the sweating process, but in the ordinary exhalations, and
was perceptible to those near him. It continued for three weeks to-
gether. No critical evacuation from the bowels took place : bat invete-
rate constipation, of which he had for years been the victim, was com-
pletely overcome by his water treatment at Malvern.

Like all other Englishmen, this patient not having any compulsory oc-
cupation, had created some, which, he thought, must be attended to : and
he left for his home in Surrey, in June, 1845. I had fears for his firm-
ness in continuing the treatment, and in avoiding the causes of his
malady. He was not cured, although he was in the high road to it, and
would still be cured with a couple of years of treatment. The following
letter, however, shows how another fit of gout was thrown out by the
viscera, and it is very probable that several such would be elicited ere
the gouty disposition was exhausted. Between the former, and this at-
tack, however, a period of nearly nine months had intervened. It will
also be seen, that my fears about the patient's sufficient prudence were
not ill founded, as witness his ** enjoyment with his friends." So that it
is no marvel that gout holds its ground to some extent still. Yet if ever
a case of gouty disorder was curable, this is it. The letter, dated in
January, 1846, reports thus :

"• I continued for some time nearly the same as when I left Malvern,
not making fast progress, nor yet standing still ; and thus I went on un-
til September, when the gout seemed determined to measure its strength
with aU-powerful water. The attack was most spiteful, and I resisted
it manfully. It paid a visit to most of my joints except the knees. I
then went to Boulogne for a few days, and never felt better. Of coarse
I was somewhat weak in the understanding, but as to gout it was quite
gone. Occasionally, since then, I have felt little pains, and then it seems
as if each of these would have been an attack, for they come on in the
old way, but the fit seems spent before gout really takes place. (The
troth is, the visceral gouty irritation is so diminished as not to suffice for
a regular attack; with prudence, it woAld be altogether worn oat)
I sweat every morning with the spirit lamp : the whole process rizty

948 EHEUMATIC GOUT.

minutes, forty of which are of actual perspiration, during which, I drink
five large tumblers of water. I find I can now enjoy myself with my
friends as much as I could wish. I take wine only new and then, and
don't care if it be a pint or so. Indeed, Doctor, you have produced all
you led me to expect, and I am very grateful for it. Life is to me quite
another thing ; I can enjoy it, and instead of looking forward to an inva-
lid chair and crutches, I am the wonder of the neighborhood : and yet I
cannot persuade my invalid friends to go to Malvern : they tell me I
have a wonderful strong constitution, and all that nonsense (his constitU'-
tion was utterly shattered when he came to Malvern). Now this I feel
more than anything, — ^that they should attribute to constitution, what is
entirely owing to your skill and learning. But say what I will, they
seem determined to die in their ignorance — ^wilful ignorance: and
serve them right too," &c., &c.

If my patient would but become a teetotaler, he would never feel gout
again.

§ Rheumatic Gout.

The exposition of the nature and treatment of the maladies
which occupy the two preceding sections, renders any prolonged
account of rheumatic gout unnecessary. Partaking of the exter-
nal characteristics of both those diseases, it also acknowledges a
similar internal condition : there is the stomach and liver irrita-
tion, with the general disorder of nutrition dependent on it. The
phase of visceral irritation, however, differs from that of ordinary
gout, inasmuch as it throws itself on any or all of the fibrous tis-
sues of the body, of the large as well as the small joints. It also
partakes more of the nervous than the chalky character of gout.
On the other hand, the rheumatic character is exhibited in the
fixation of pain in the large joints and fasciae, in the extreme sen-
sitiveness of the body to barometric, thermometric, and electric
influences, and in the comparative frequency of the disease as an
accidental, and rarity as an hereditary infliction.

But the chief point to ascertain is, not what to designate the
disease, but what stage of visceral irritation is to be treated. As
I have said, the most usual is that which corresponds with ner-
Tous gout and neuralgic rheumatism. The difiiculty of treating
such a combination, will be readily understood from what has
been said on each of those states. In fact, rheumatic gout is a
trial for the physician's skill and patience, as well as for the
patient's power of endurance. Sudden feverish attacks, theu
•gain symptoms indicative of obstructed rather than excessive

HHBT7UJLTIC 6017T. 249

Action, inoeasant shifting of the seat of pain, and variety in its
character, render this one of the most tedious of diseases to bear
or to treat. However, the treatment must turn upon the fact of
obstruction or excessive action, the rules for which will be found
under the respective heads of rheumatism and gout. In the ma*
jority of cases, the wet-sheet packing is the principal remedy,
with an occasional and rare sweating. In other cases, again,
this proportion is reversed, and the wet sheet is used only from
time to time to keep down feverish excitement. In both sets of
cases, the douche is an important remedy, and is employed
either as a tonic, when the wet sheet has reduced the visceral
irritation, and left the body low, or as a stimulant in aid of the
sweating in its action of rousing obstructed and torpid functions.
Copious water drinking is necessary in all cases, except those
which exhibit a fulness of the head.

To be of permanent benefit, the water treatment of rheumatic
gout of long standing should be continued for at least fifteen,
eighteen or twenty-four months. In the course of my practice,
I have been enabled to bring considerable relief in several cases,
by lengthening tlie period between the attacks, and by shortening
the attacks themselves : but the treatment did not exceed three,
four and six months in duration, and was altogether inadequate
as curative of disease of seven, ten and twelve years' standing.
Still, I have not the least doubt that rheumatic goiU is perfectly
curable by the water treatment, if time be given for it. Indeed,
one case I have cured, in which, from the recent date of the dis-
ease, and the youth of the patient, less time was required, and
sufficient time was afforded for the thorough operation of the
remedies. The patient was only thirty-two years old, and had
been afflicted only two years : so that by the brisk and persever-
ing action of the treatment during nearly five months on a tole-
rably good constitution, the pains disappeared altogether, and he
left Malvern having an understanding with me that if they re-
turned, he was to inform me. It is now eighteen months since
that time, and I have heard nothing of the patient or his com-
plaints. With time I would readily promise cure in much worse
Cjaaes than this.

12*

850 DISEASES OF THE COI<ON —

CHAPTER V.

DISEASES OF THE LOWER ORGANS OF DIGESTION— DISEASES
OF EXCRETORY ORGANS.

Uses of excretory organs — ^Erroneous ideas concerning constipation — Actual
function of the lower bowel — Rationale of excretion — Dependence of
constipation on the nervous and circulating systems — Constipation with
sufficient and with insufficient blood in the body — Its treatment accord-
ing to the presence or want of blood — ^Different kinds of Piles— -A symp-

. tomatic disorder — Connection with obstruction of liver, heart, and other
organs — Constipation as a cause — Danger of operations for piles — Treat-
ment — Mode of origin of functional Dropsy — Action of the kidneys in
it — Absurdity of diuretics — True aim of treatment — Pathology of skin
diseases, acute and chronic— Rationale of their outbreak and suppression
— Treatment

Commencing with the diseases which assail the bipod-making
organs, the stomach and lungs, we have spoken of those of the
heart which circulates the blood, of the nervous system which
regulates its circulation, and of the limbs which are commanded
by the nervous system. It remains to speak of the morbid states
which obtain in certain organs, whose function, as regards the nu-
trition of the body, is rather negative than positive. They assist
in the maintenance of the body by eliminating from it matters
which, if retained in the circulating mass of blood, would deteri-
orate its power of directly nourishing the various organs in n
healthy manner. Thus, the retention in the blood of the elemenis
which form the faces, the urine, the sensible and insensible perspi-
ration, gives rise to the most formidable as well as the most tedi-
ous maladies : formidable, in their acute, and sometimes in their
chronic form, in which latter they are always more or less tedious.
It is'scarcely necessaiy to add, that the organs which carry on
these functions are the colon or lower bowel, the rectum, the ki(L
neyj, and the skin. As in the case of other organs and functions,
I shall only speak of thd^e which I have treated by the applianoea
of the water cure.

CONSTlPAiK^V. S51

§ L DiSflBASES OF THE CoLON — CoNSTIFATIOM.

On no subject of medical concern is there more misooncepticm
and prejudice among the laity, than on that of the depuratory of-
fice of the bowels. And no wonder : withih the first twenty-four
hours of mundane existence an aperient drug is introduced into
the digestive canal, and that irritative action, thus conunenced, Is
looked on as necessary to the well-being of the individual,, by
those whose office it is to watch over his younger years. By the
tii*ie he has reached the years of self-gu Idance, the same neces-
sity is impressed on his own mind, both fr m the mental habit, and
from the organic craving of the lower b wel itself, for the daily
or weekly excitation of the aperient : — a craving which induces
a sympathetic one in the brain, which wUl not be satisfied until
tlie old irritant is applied to the old spot. No mc^tter how perfect-
ly well the person may be, appetite, sleep, spirits, walking power^
in the best order, no pain or ache present, no sense of fulness of
the bowels : yet he is haunted by this vision of constipated bow-
els : all must go wrong, if all be not already wrong, unless his
bowels are relieved : they were open yesterday, the day before,
and for a year past, but not having been open on this precise day,
the worst must happen. How hard, all but impossible, it is to
drive into the understanding of patients that all this is error, every
medical man of physiologic&] education can say. It would seem
as if people lived to have stools and not had stools to live. These
last seem, with large classes of English society, to be the alpha
and omega of earthly existence, the one thing of never fading in-
terest, the much loved object of daily and hourly solicitude : all
the gigantic efforts of the reasoning faculty, all the empyrean
flights of the imaginative faculty are postponed for the elevating
function of evacuating the bowels !

It is sad folly, all this anxiety about the bowels : and much of
it is at the door of the patient who has grown up in it. But the
fault is also shared by great numbers of the lower class of medi-
cal men, called surgeon apothecaries, who either do not know the
physiological merits of the subject, and act in ignorance, or else
are too indolent steadily to resist the patient's prejudice for the
patient's good. These, the ordinary attendants of so many fami-
lies, might do much to abolish this pestilent and intolerably stupid
habit and prejudice of purging the bowels, — ^the parent of so many
diseases which shorten life, and of so many more which render

•*2d2

DISEASES OF THK COLON —

life scarce worth having. To the non-professiona readers of this
work I will, at least, offer some explanations cpnc€;-ning the office
of the colon, which will show them the uselessness and harmful-,
ness of interfering with it, and also how the natural, unforced ac-
tion of the bowels is the only one which is not harmful to the
body.

After being formed out of the food by the offices of the stomach
and lungs, the blood is passec on to the minutest blood-vessels of
all the tissues of the body. In these vessels, the great function?
of nutrition and secretion are carried on: nutrUUm depositing, the
solid parts and secreti a the liquid and gaseous. But all the
solids and the greater number of the liquids are only deposited
from the blood for a time : their status quo is most transitory.
The solids are broken down, and, by the absorption of the veins,
again carried into the torrent of the circulating blood. The same
takes place with regard to the liquid and gaseous deposits from
the blood. Every particle of brain, bone, muscle, sinew, &c., is
reliquified : and almost every drop of mucus, saliva, halitus, bile,
&c., is re-absorbed, and re- circulated. The chemical elements
of all the solid deposits and of all the secretions are therefore in
the blood.

Now there are certain of these secretions, which exist for the
purpose of carrying off from the circulating blood chemical com-
pounds derived from the breaking down and reliquifaction of the
solids of the body. Those compounds are called nitrogenized,
nitrogen being the element they chiefly contain. The elimination
in question is effected in the kidneys by the secretion of urine,
and in a portion of the colon hy the secretion of the stools.

The object which nature has in the secretion of the stools is,
therefore, to rid her circulating blood of matters which, being no
longer of use for the purposes of nutrition of that body, would in-
terfere with it, if retained in the blood.

This is so true, that there are instances in which the colon
failing to secrete the fseces, the skin has been made the point of
elimination to a most disgusting extent. I have myself seen
several persons in whom the exhalation from the skin had a strong
fseca! odor from this cause. Moreover, any one in ordinary
health may observe, that when, from any cause, a smaller quan-
tity of stools than usual is secreted, a larger quantity of urine is
passed, and vice versa, nature ridding the bl(x>d by one channel
when the other fails.

CONSTIPATION. 25S'

The fseces, then, are to he regarded as a secretion from the
mucous memhrane of the colon, just as gastric juice is a secretion
- from the same memhrane of the stomach, the tears from the mu-
cous membrane of the lachrymal glands, the wax from that mem-
brane of the outer ear, &c. In short, their production is exactly
similar to that of any other secreted matter of the body ; but inas-
much as they are secreted for the purpose of being thrown out of
the body, they are called an excretion more commonly than a
secretion. Here I would remark, as I have done in several
places before, on the mischief of dealing with riames instead of
acts. Because stools are called excrements, people get it into
their heads that it is always there, in the bowels, to be passed offj
and must be passed off, without the slightest reference to the other
effects of the means they use for hastening the excretion, and
without asking themselves the very simple question, " whence
come all these faeces ?" Yet it is one which, properly answered,
would have prevented many a mortal malady, and saved a world
of mental and bodily suffering to tho crowds of colocynth eaters
that are to be found in England.

" Whence come the faeces ?" Unquestionably from the same
source as all the other secretions of the body— ^rom the hlood ;
from the blood which circulates in the mucous lining of the colon.
Sometimes there are portions of undigested or indigestible food,
such as the skins of fruits, and the husk of oatmeal, mixed up
with them, having been untouched by the gastric juice: but
these are adventitious, and not an essential part of the stools.
These last, therefore, being secreted from the blood, must derive
their quantity and quality from the quecntity and quality of the
blood at the time distributed in the lining of the colon.

But as this blood circulates in blood-vessels which owe their
vital irritability to the ganglionic nervous matter (see page 4),
with which they are supplied, it follows that the fsecal secretion
also depends upon the condition of the nervous matter in ques-
tion. As in the other secretions of the frame, the first influence
of causes is upon the ganglionic nervous matter, which then altera
the contractile action of the blood-vessels of the colon, this, again,
altering the quantity of blood in that part, and the consequent
secretions from it.

Thus we see that the secreting action of ike colon depends upon
ihe quandiy of hlood in its vessels, and the quality of the nervoui
^ency operating upon them.

094 H£MORSHOI3>8 OB PII.ES.

This materially altered the character of the fjeces, and relieved Hm hetd

eventually, though it tried it at the moment. Persisting in all the above
treatment for five weeks more, external piles began to protrude, which in
a week or ten days began to bleed, at first in small quantity, and only
once in two or three days, but, after a time, daily and freely. The relief
to the head, however, dated from the first few drops that were given out ;'
all that was needed to reUeve the symptoms being a bond fide critical
action, which these few drops of blood evidenced.

From this date the patient went steadily on towards amendment, the
pain of the rectum disappearing with the free flow of blood, just as that
of the head had done with the smaller loss. At the end of sixteen weeks
of treatment the piles had altogether gone, and it only remained to
employ tonic treatment to make up for the Uood that had been lost, and
to put his general system into better order ; which, indeed, had been in
some measure effected during the treatment for the piles. I should
mention, that when the bleeding became free, the sitz baths were con-
siderably reduced in duration, and the wet-sheet packing discontinued
altogether ; that being the best means of leaving nature to bring about
her own cure ; for when she has once set up a critical action of any sort,
the less we interfere the better.

When we have to treat bleeding piles, the sitz bath \s the chief
remedy ; but it requires much discrimination in its use ; for if it
be employed so as suddenly to arrest the flow of blood, some im-
portant organ, especially the brain, is sure to suflTer. The prac-
titioner should ascertain the precise state of circulation in the
diiTerent internal organs, and how far each is able to resist the
transfer of irritation from the rectum, for tluit is what takes place
when bleeding from piles is suddenly stopped. Upon the know-
ledge he obtains on this point he regulates the temperature, dura-
tion, and frequency of the sitz baths. Should there be any
general feverishness attendant on the graducd stoppage of the
piles, or should signs of transferred irritation to some internal
organ appear, recourse should be had to the wet-sheet packing in
the first case, and with the addition of a longer sitz bath in the
second. Very little water should be drunk. The compress
should only be worn part of the day, and then frequently fresh-
ened with cold water. Very little animal diet should be taken,
and a proportionately small amount of exercise. In flne, it should
always be kept in view in the treatment of bleeding. pilesy that thej
are themselves efforts of the body to subdue mischief in some
noble organs, and that all we have to do is to take care that the
effort, that is, that the loss of blood attendant on fhe efiK>rt should

mtopsr. 376

not be more than the body generally can bear, xi the one hand ;
and that to arrest the effort suddenly, that is, to stop the loss of
blood suddenly, would be to throw irritation back on the noble
organs, which are striving to save themselves through the agency
of the rectum.

§ 8. DsoPST.

The morbid accumulation of liquids in some of the cavities of
the body, or underneath the skin, is always accompanied by a
suppression of the secretion of urine ; and this is one reason for
placing dropsy in the present chapter. It would, however, be
erroneous to suppose that dropsy depen4s only on suppressed func-
tion of the kidney. On the contrary, this suppression is more
commonly the consequence of the dropsical action in some of the
cavities of the body. But the organ whose suppressed function
acts as a cause of dropsy, is another veistly important excretory
organ — the skin. The process of dropsical effusion is more com-
plicated than is commonly thought. I proceed to state it.

A man irritates his stomach and liver until the circulaticm in the
skin becomes utterly deranged ; its vitality is sorely diminished,
its power of resisting external temperature almost abolished, and
its excretory function arrested. How liver and stomach disease
bring about this condition of the skin has been already shown
when treating of those maladies. And it is to be remarked, that
the great majority of dropsical cases are of spirit drinkers who
have diseased livers. The quantity of vaporous fluid given out
by the skin is something more than forty ounces in the day.*
This quantity being more or less diminished with the diminution
of vitality in the skin, the fluid thus arrested is retained in the
circulating blood. But as the blood would be burdened and the
solids irritated by its presence and bulk, nature seeks some other
surface by which she may throw off the fluid in question. This
is found in the membrane which forms the outer covering of the
lungs (the pleura), in that which forms the outer coveidng of the
bowels (the peritoneum^ or in the -cellular tissue, which lies be-
tween the skin and the muscles of the trunk and limbs. And

* Sanctoritts, Dqdart, Keill, De Gortxr, Robinson, Rte, Linino,
Lavoisier, Segxjin, Abernethy, Cruikshank, and others, give very
discordant calculations of the amount of transpiration; but the above is an
^iproach to the average in temperate climates and weather.

8T0

according to the point chosen, dropsy cf the chut, dropsy of ^
heUyj or dropsy of ike skin (as it is improperly called), is gene*
rated. It shoold be remembered that all these parts, the pkuruy
the. peritoneumy and the cellular tissue, are always exhaling, in
their hedUky state, a fluid very similar in composition to the ex-
halation from the skin. . When, therefore, they become dropsical
in their action, it is a transfer of function from the surface of the
. skin to their surfaces. However, this transfer of function implies
additional organic labor and additional quantity of blood in the
dropsical membranes; and dropsy has therefore been very pro-
perly regarded by sound pathologists as a chrome inflammation of
the parts which pour out the excessive fluid. In dropsy of the chest,
there is chronic inflamiipition of the pleura ; in dropsy of the
belly, chronic inflammation of the peritoneum ; and in anasarca,
or dropsy of the skin,. there is chronic inflammation of the cellular
tissue underneath the skin.

Now, suppose that, in addition to the ' want of vitality of the
skin acting as a cause of its diminished excretion of sweat, exter-
nal cold should play upon it, unable as it is to resist diminished
temperature ; it is easy to conceive that such cold would further
drive blood from the skin, and further diminish the secretion of
fluid there. But this would also further drive blood Upon some
of the membranes above mentioned, and engender dropsy of them.

Accordingly, it is found that the condition of body which leads
to ftmcdonal dropsy is an irritated, congested and exhausted state
of the nutritive viscera, inducing diminished circulation and exha/a-
Hon of sweat in the skin ; that this diminished exhalation leads to
increased exhalation in the parts affected by dropsy; and that the
increased exhalcUion impUes a phase of chronic inflammation in those
parts. As regards the exciting cause, cold, and especiaUy damp
cold, applied to the skin, is the constant cause.

In accordance with this view, it is found that, whatever causes
and maintains a state of chronic irritation and exhaustion in the
digestive viscera, conduces to dropsy. I have already alluded to
spirit drinking as acting in this way : but excessive losses of
blood bruag about the same result : as also long continued mental
irritation, especially of the sorrowful kind : even sedentary habits;
by inducing hepatic and stomach congestion, are sometimes the
predisposing causes of dropsy. Nutrition, wrong at the centre,
languishes at the surface, and external agents then help to increase

die difloidered fimctions which follow on the want of vital eqnili-
biium. This ia the history of all chronic disease.

Decreased dbsorption of fluid has been supposed to he a very
efficient cause of dropsy, but the argi^ments for such a state are
few and feeble, whilst those for increased deposit of fluid are many
and cogent. There is the soundest ground for belief that all the
phenomena of increase or decrease of fluids of any kind in the
body, are dependent on increased or decreased secretHm, and not
on varying degrees of absorption^ a process usually stationary in
degree. And as regards dropsical collections, it appears inoon-
■istent to speak of them as caused by diminished absorption, when
that is never mentioned as a cause of preternatural accumulation
of mucus, fat, bile, saliva, or any other secretion of the body ; as
well as extremely gratuitous to suppose that the vaporous fluid of
the dropsy is alone deficiently absorbed, while the absorption of
every other fluid and solid part goes en as before. If this were
not the case, how could we explain the great emaciation which is
so frequently attendant on dropsies ?

All this time nothing has been saiJ of the kidneys^ upcm which
the whole blame of dropsy is so commonly laid. But in . truth,
the kidneys have little or nothing, to ^o as a cause with functional
dropsy. They secrete very little urine in dropsy, but that is the
consequence not the cause of the dropsical irritation. In treating
of constipation, I have shown how chronic irritation of the stomach
or of the brain and spinal cord produces that state : how, in fa<^,
they arrest the secretory activity of the lower bowel. Precisely
in the same manner does dropsical inflammation of the chest, of
the belly, or of the cellular tissue under the skin, produce a dl-
ininution in the secretory action of the kidneys. Nor «re those
organs singular in that respect : for dropsy arrests the secretion of
the lower bowel itself, producing constipation of the most obstinate
kind ; of the skin, causing dry, harsh, parchment surface ; of the
mucous membrane, producing dry tongue, intense thirst, &c., dec.
So that there is no difficulty in accounting for the inactivity of
the kidneys in dropsy: — ^the dropsical surface,. with its preter.
natural accumulation of blood and organic activity, diminishes or
arrests the healthy activity of the kidneys. This exposes the
folly of turning all attention to the forcing of those parts to pour
out urine by the administration of medicines called diuretics, but
which, in fact, can only act by setting up in the kidneys a counter.
inrttatioQ to the dropsical inflanunation of the belly or other a&

978 DBOP6T«

looted part. In short, the parallel with coostipation is complete
here too : for purgative medicines act in exactly the same way
with regard to the lower bowel and the cause of its constipation
situated elsewhere. Diureiics draw, for a time, blood and organio
energy to the kidneys from the dropsical p%rt : purgatives do the
like in the lower bowel. When the kidneys pour out urine^ it is
a sign that the belly or other cavity is relieved of its dropsical
inflammation, not that the kidneys have relieved it ; for simul-
taneously with tkeir renewed activity is the renewed secretion of
the skin, of the mucous membranes, of the liver, &c.: all are set
at liberty by the cessation of the inflammation in question*
Meanwhile it may be said, that the cessation of the urinary
secretion throws a further quantity of fluid on tlie circulat.
ing blood, and thus augments the dropsical tendency ; and
the daily quantity of urine secreted, amounting to about
thirty -two ounces, added to the liquid which is arrested in the
skin, renders this a not unimportant consideration in esti-
mating the quantity of fluid sometimes secreted in dropsical
swellings.*

These pathological facts and reasonings have an important
bearing on the trbatment of functional dropsy ; and that is
my* reason for dwelling on them. For, the irritation and exhaus-
tion of the nutritive viscera being given, the feeble vitality and
suppressed secretion of the skin being ascertained, as causes^ it
renders sufficiently clear what the chief aim in treating the efectt
the dropsical inflammation, should be. It is essential to re-estab-
lish the secretory activity of the skin, and thereby to counteract
both the irritation of the viscera, and the dropsical inflammation.
But as that inflammation is of the atonic kind, occurring as it
does in enfeebled and generally bloodless frames, it behoves to
give tone to the digestive organs, so as to ensure the formation of

* SAxcTORi'd^s estimates the urine at 16 ounces ; Keilii at 30 ; Prout at
32 ; BosTocK at 40 ; Haller at 49. I have'follDwed Prout As regards
the quantity of dropsical fluid reported to have been deposited, it is some-
times enormous. Seven thousand pints are said to have been voided by the
same individual at several openings. Dr. Weatherheab (Lond Med.
Trans., 1828) gives a case where the belly was tapped 47 times, and the
man lost altogether 566 pints. This operation has, however, been per-
formed on the same person no fewer than 150 times (Phil. Trans , 1775),
and upwards of 1,000 pints of fluid have been voided (Scott, Med. Comm.,
1T78). In one case related by Storck, 100 pints of liquid were evacmtsd
itroaa opening, equal in weight to ftMiit two-thinb of tfaei whole hoAf

good, nutritious blood. And these aims the appliances of the
water cure are eminently fitted to fulfil.

From time to time cases are recorded of spontaneous cures of
chronic dropsy by natural profuse sweatings. Even when the
dropsy owns an irremovable cause, such as organic disease of the
heart, nature sets up excessive action of the skin as a means of
prolonging the struggle for life. In the water treatment this is
imitated. If there be no feverish action of the pulse, skin, head,
d^., to require some preliminary wet-sheet packing, we proceed
at once fo sweat the patient ; and this must be practised with
nice reference to his organic fK)wers, having care not to over-
strain them by too frequent or too long sweatings. It is, for the most
part, exceedingly difficult to excite the skin to sweat .in dropsy;
in which case we must be content to employ heating in blankets
for a few days, and thus get on to the free action of the skin, with-
out taxing the head too much. Every one knows how cold the
skin of dropsical patients always is, and how much better they
are in a warm atmosphere : their kidneys are always more free
in that condition. Sweating, then, is the chief remedy in chronic
dropsy ; and it should be followed by a shallow bath at 60^.
Next to it comes the tepid sitz bath, which should be extended to
twenty or thirty minutes. Hot fomentation of the belly is also
very recommendable, especially where there is a great degree of
hardness and sharpness in the pulse ; it should be practised for
half or three-quarters of an hour eaoh night at bed-time. Like-
wise, if that state of the pulse, accompanied by feverish heat^
arises in the course of treatment, as it perhaps may from the
stimulus of sweating, a towel packing should be had recourse to
now and then, without, however, stopping the more important
sweating process. The compress should be worn day and night,
and the damp part of it should be well covered with oiled silk or
some impermeable texture, otherwise it is very likely not to be-
come warm. In addition to these humid applications, frequent dry
friction of the trunk and limbs should lie employed. Waf'er
should be drunk very freely, even more than the great thirst
requires; for it then not only tends to subdue the dry and
feverish state of the mucous membrane, but also by its cold,
to induce appetite. It is almost needless to signalize the old
error on this head : all educated medical men, and even
many surgeon-apothecaries, now order free water drinking t«
diopvcal potieats. The diet titkoiM be rather of animal ohftn

980 DROPSY.

acter ; and the vegetable matters taken of the highly nutritious
kind, such as bread. Long previous disorder of the nutritive
viscera has rendered the blood of dropsical patients exceedingly
poor in* the richer constituents, and what is called << watery" blood
circulates, and maintains, by its inaptness for healthy nutrition
of the solids, the aionie inflammation which is the proximate cause
of dropsy. It behoves, therefore, to employ the digestive organs
upon what will yield the greatest amount of these richer constitu-
ents, and not to waste their powers upon less nutritious matters ;
the rather if the appetite be deficient. But concentrated soups
are singularly prejudicial in dropsy ; the solid red meat, in pre*
ference to poultry and other white meats, is the best form of ani-
mal food, which should be taken once at least daily, and twice on
alternate days. Abundant exposure in the open air, if the wea-
ther be- mild, should be made ; but any exercise but passive is
bad, at least until the kidneys begin to act, that is, until the drop-
sical inflammation is subsiding. ' .

The earliest sign of this subsidence should be marked. When -
the pulse becomes slower and stronger, the skin warm and more,
supple, the mucous membranes moister, the temperature of the
water employed for the shallow and sitz baths should be lowered
by speedy degrees, and the tonic appliances made to bear upon
the debilitated organic powers of the patient. This need not in-
terrupt the sweating, which should be carried on simultaneously,
so as to aid the transference of irritation, and to remedy exhaus-
tion at the same time. And this should be continued until the
renewed function of the kidneys and of the lower bowels is added
to the healthier mucous membrane of the stomach and mouth and *
the more natural skin ; at which point the sweating should be
gradually discontinued, and the tonic treatment made predominant,
and at length sole.*

This outline of treatment, well filled up by the physiological
tact of the practitioner, will seldom, *'f ever, fail to cure chronic
dropsy, which is purely functional, and does not depend on orga-
nic disease of some important organ. It proceeds upon the.
rational principle of remedying the radical exhaustion and irrita-
tion upon which all the phenomena of the disease turn, — the ex-
haustion of the nutritive viscera, and the irritation of the dropsi-
cal part. This the sweating does, rousing the secretory and .di-
gestive energies of the stomach and liver, and bringing about a
transfer of irritation from the dropsical oigan to the skin : the re-

•nit of which is a release of the kidneys from the torpor of op*
presnon imposed upon them hy the organ in question, and a re-
establishment of the secretions in all parts of the body. Their
re-establishment ensures a free exit for the watery portions of the
blood in other parts than those dropsically affected, and these last
therefore cease their excessive, and take on their natural amount
of secretion. The dropsy is cured. But when you attempt, ■■
is commonly done, to cure it by divreUcSy remedies which are
supposed to act upon and urge the kidneys, you do not succeed^
because you begin at the wrong end ; you treat the effect instead
of the cause : the stoppage of the kidneys is not, in any case, the
efficient cause of dropsy, and mere diureUcs cannot cure it. It is
said that mercury has cured dropsy, and therefore it has been
placed among diuretic drugs ; but that is a non sequitur : the
mercury cured by its tonic action upon the relaxed blood-vessels
of the dropsical membranes, — ^an action it is well known to pos-
sess, and not by direct stimtilation of the kidneys : in other mala-
dies, mercury does not increase the quantity of urine. It is the
only medicinal agent that has any chsince of overcoming dropsi-
cal irritation : all the &rrago of vegetable and saline messes, used
as diuretics, are worse than useless: they have no power over
chronic inflammatory action, and they disorder the stomach. Nor
does mercury cure without leaving its mark behind in the shape
of nervousness, neuralgia, or some other form of neuropathic de-
rangement.

Dropsy which depends on organic disease of the heart, of the
liver, or on the pressure of internal tumors upon the veins, which
bring back the blood to the heart, is not curable. But it is ca.
pable of much palliation by the water treatment, as I have seen
in three cases. The treatment is, as nearly as possible, the same
as that above propounded : for the pathological condition is the
same. The blood, impeded in its progress towards and through
the heart, flows back upon the capillary veins, congests them, and
this congestion acts as an irritant to the . capillary arteries, of
which the veins are a continuation. This irritation of the ca-
pillary arteries constitutes the dropsical state heretofore alluded
to ; and the stoppage of the secretions of the kidneys, of the mu-
cous membranes and of the skin, follows as in ordinary functional
dropsy. Thus, for instance, as all the blood which returns by
the veins from the viscera of the belly has to pass through the
tiv«r before it reacheathe heart, the obstruction pf the liver by

282 DROFJT.

organic, irremediaUe disease, is a cause of dropsy of the hetfy, .

by throwing that blood back upon the belly, congesting the ve-
nous, and thereby irritating the arterial capillaries. Now, al-
though in this case the mischief does not begin in the skin, yet a
partial and temporary transfer of it to that surface, in the act of
sweating, procures a relaxation of all the secretions, for a time :
and thus, with an irremoveable cause at work, much of the dis-
tress of dropsy may be relieved, and its inevitably fatal termina-
tion postponed. I am confident of having prolonged life, in one
instance, more than two years, by. the palliative application of the
water treatment. In that case, the treatment, besides causing
temporary transfer of the dropsical inflammation to the skin, in-
duced appetite and digestion, which enabled the nutrition of
the body to go on for a considerably longer time than they could
otherwise have done.

The following case of functional dropsy, which came under
ray notice a year and a half ago, will illustrate what has pre-
ceded on that subject :

Case XXX. — ^Dropsy of the Belly and Skin.

The patient, forty-six years old, had brought on a great amount of dis-
ease of stomach and liver by daily and incessant tippling of spirits, wine,
beer, anything that came in his way. He became pale, bloated, short-
breathed, and had the short, dry, ringing cough of diseased duodenum
and liver. His urine, at first thick, became scanty ; his feet began to
swell and pit, but all his other limbs were shrunk, whilst the belly be-
came more and more tumid. It was plain that dropsy was commencing.
Recourse was had to medicines ; he took abundance of diuretics, but the
water steadily accumulated. Strange to say, that stimulants were not
withdrawn, the very agents which caused all the mischief. At length
his friends contrived that he should reach Malvern, after vehement oppo-
sition on the part of his wife, who protested against the withdrawal of
" all support," as she called the alcoholic liquors. When he came to me
his legs were hard with water all the way up, but, of course, more so
towards their lower parts. The belly was immensely swollen, the upper
part with wind, the lower part with water as well as air ; and there was
some tenderness on pressure, and when it was tapped sharply with the
finger. The pulse was excessively rapid and jerky. The breathing
thick, short, husky. The thirst was intense, the hunger nil. The breath
hot and acid. The eyelids bloodless. The skin utterly pale everywhere,
without the slightest moisture, but glistening. Bowels very torpid, and
their faeces colorless. Sleep very broken, and disturbed by horrid dreams.
This state of things had exi.^ted for between four and five months.

The jerky and hard condition of the pulse, and the bad deep, ted m$

\ BR0P8T. 988

to ttse fomentatioin to the abdomen of this patient for a few days in tin
outset These, with a general ablation in a shallow bath at 80°, the
compress to the belly, and abundance of Water to be drunk, constituted
all the treatment for a week. He todi: very little food ; and, it being ex-
ceedingly cold weather at the time, did not go out. The symptoms,
however, for which this treatment was employed, abated sufficiently to
permit of the sweating process, to which he was subjected on the ninth
day after his arrival. It seemed immediately to act upon the visceral
irritation, the thirst became far less intense, the bowels acted a little
better, and the urine was triffingly increased, after four days' sweating.
This daily sweating, a sitz bath at 8d^, taken twice a day for twenty
minutes, the shallow bath as before in the early morning, the compress
on the stomach day and night, and eight or nine tumblers of water in
twenty-four hours, made up the treatment for the following three weeks.
He ate a little meat once daily, and took milk and bread morning and
evening. Under the operation of the above plan he gained an excellent
appetite and good sleep; his bowels improved vastly in quantity and
quality of evacuation ; as did the kidneys, although the urine was not so
copious as might have been expected, looking to the immense quantity of
dropsical floid accumulated.

The cause of this was shown in the sixth week of the treatment.
After forty-eight hours of considerable constitutional disturbance, and
intolerable tingling and itching of the legs, enormous blebs made theii*
appearance in various parts of the limbs, filled with the dropsical liquid of
the skin. Some of these I pricked and emptied, and others I left alone.
But as the latter enlarged by the liquid burrowing, as it were, I opened
them too ; the rather as all of them, when opened, continued to discharge
large quantities of Hquid day and night, which, in the course of ten days,
reduced the legs to a very moderate consistence and size. In several of
the blebs, the skin underneath took on a purplish hue, and threatened to
give trouble and anxiety ; but compresses of hoi water altered their ap-
. pearance in four or five days. Here, then, was such a crisis as I do not
remember to have seen described ; dropsy of the cellular membrane un-
derneath tlie skin departing by blisters raised upon the skin. It accounted
for the small increase of the urine, which was quite insufficient to account
for the relief of both dropsical parts — ^the belly and legs, but was sufficient
to account for that of the belly, whilst this exudation from the legs dis-
posed of Iheir swelling.

Total reduction of the dropsical swelling in both parts was elfected by
the end of the eighth week of treatment. And as, after the appetite ap-
peared, it never disappeared or diminished, he was gaining ground in
general health the whole time of the immense discharge from the legs,
which continued, in all, for three weeks. During that time the sweating
was only employed four times, as a means of procuring greater activity
of the bowels, which it always achieved. Otherwise nothing was done
Ifut wearing compresses on the legs, the morning ahaltow batfa^ aiW

284 BVIN DISEA8]SS. /

two tepid sitz baths, with the flame quantity of water aa before* After
the removal of all dropsical action, he was submitted to the tonic parts of
the water treatment for three or four weeks more, by which, and abun-
dance of fresh air, he came to make blood rapidly, and gain flesh, and
color, and strength of limb. I am told that his revived appearance and
powers astonished those who had seen him before he left for Malvern,
as they thought, dying of dropsy, but likely to be hastened to his end by
the treatment he was about to undertake.

I have treated two other cases of general dropsy of the skin
with success, and in a very similar manner to the above. But
in them no blebs arose, and the renewed and copious action of
the kidneys was the only signal of diminished dropsical action.
Both cases were of persons worn out by previous excesses, and
having deteriorated digestive and blood-making powers : in one of
them mental distresses aggravated the difficulties of the case.
I have had no opportunity of treating by the water cure any case
of functional dropsy of ike chest : but there is no ground for doubt*
ing the benefit which would be derivable from that mode of treat-
ment, the morbid condition being the same as that of dropsy of
the belly, which, as well as dropsy of the skin, is perfectly curable.

§ 4. Skin Diseases.

All morbid phenomena have been very properly regarded by
scientific medical observers as the result of efibrts on the part of
nature to rid her noble parts of some grievous mischief.

The • phenomena in question are those of perturbation of the
entire nervous and circulating systems ; perturbation which only
ends in the critical concentration of irritation on some excretory
organ, and critical termination of this latter irritation in augment-
ed excretion. Strictly speaking, fever is a skin disease, the skin
being the organ to which the visceral irritation is transferred. If
that irritation be not too great for the organic power of the viscera
entirely to transfer to the external surface, it remains in them,
destroys their function, and, with that, the life of the individual.
If the viscera do possess sufficient power to effect the transfer in
question, the irritation thus set up in the skin is eventually relieved
by the copious secretion of sweat from the overloaded and dis-
tended Wood-vessels of the skin, both viscera and skin recover
and the life of the individual is saved.

]^i.0w, T^en a certain and very intense phase of visceral irri-
tatioB obtains, more especially when it has been excited by the

SKIN DISBASBS* 8W

ji a rem noe of a poisonous matter in the circulating blood, an amount
of irritation is thrown upon the skin, so great as to raise acuta
inflammation there, which ends in small points of toaienf seoretioo
called vesicles, or pimples, such as chicken-pox ; or of purulaii
secretion called pustules, such as smaU-pax, At other times the
inflammation of the skin thus produced spreads abroad, is diffused,
rather than concentrated in the points I have mentioned ; and then
we have such diseases as measlesy scarlet fever, erysipelas, and
other rashes. All these maladies, although named according to
the phenon^na exhibited in the skirij are in fact only the outward
and visible signs of an inward, and, if retained, destructive irri.
tation of the primary nutritive viscera. Thby are,, in short, ordi-
nary fever, with the addition of an eruption ; and the amount
both of fever and of eruption has reference to the amount of in*
temal visceral irritation, and of the organic power of the viscera
to transfer it to the surface. We find in all these eruptive fevers,
that if the eruption be not free and sufficient, the general per-
turbation is greatly increased, and the viscera often sink under
their irritation and . the effort to throw it out ; it is thus when
measles, scarlei eruption, &c., kill. Dr, if they be sufficiently
exhibited, their sudden suppression kills by throwing back upon
the viscera the irritation of which they had rid themselves by the
eruption itself.*

Such are the pathological facts with regard to acvie diseases
of the skin. What is the phase of visceral irritation whioh pro-
duces, .or wherefore it produces, one form of eruption and not
another, is one of the many arcana which Nature has not yet un-
veiled to the student of diseased life ; and, in all probability, never
will. But the process of their origin, which I have briefly de-
veloped, is one of the best established points of pathology \ and

• In speaking of the pathology of skin diseases, it is necessary to refer
to the anatomical connection between the internal mucous membrane which
lines the viscera, and the external mucous membrane t or true skin, which
covers the body. They are, in fact, continuations of each other by the dif-
ferent orifices of the mouth, nostrils, anus, &.c. The inner membrane
pours out mucus, which is re-absorbed, or assists in the functions of the
viscera; the outer membrane pours out mucus also, but which, being
chemically acted on by the oxygen of the atmosphere, thickens, hardens
and forms that which is commonly called the skin, but is, indeed, only in-
organized mucus. This anatomical ajj^d functional parallel between the
two surfaces aids the well-known pathological facts recited in the text re-
fNding the visceral origin of skin disease.

Wbl skin BUUSA^aS.

Ume ohserratioiui of piuetise amply confirm it, as I shall preffui^jr
ahofv.

Well, precisely the same mode of origin applies to chronic skin
dioaasea as to octtte. There never was and never will be a chro-^
nic skin disease without some phase of visceral irritation ; and
skin disease is the manner in which that irritation is at once ex*
hihited and kept from exciting more serious phenomena in more
important organs. Any one who chooses to observe will see this
verified ; he will see an external eruption disappear, and giddi-
ness, headache, sickness, indigestion, heart palpitations, bronchitis,
asthma, nervousness, mental irritation, or even insanity, ensue ;
and he will see these ailments disappear with the re-appearance
of the eruption. He will see, further, that mental disturbances
and errors of diet, both of them acting through the primary nu-
tritive Cleans, aggravate the skin disease, if they be within cer-
tain limits ; as if the additional irritation to those organs was
just sufiicient to urge them to a more vigorous eruption on the
surface ; but that if they be excessive, they suppress the eruption
and produce serious internal mischief. In. this last case the
visceral irritation is so much aggravated, and the viscera them-
selves so oppressed in their function, that they can no longer
efiect the transfer to the skin. The operation of sudden surprise^
especially if it be painful, will often dry up a moist eruption, or a
chronic ulcer, because it excites a degree of visceral irritation
greater than that which is on the surface, which is therefore
dravm in, not repelled. On the other hand, a lingering mental
process, such as anxiety, causing a stream of excitation to pro-
ceed from the brain to the nutritive viscera, generates there an
amount of irritation which is proportionately shown on the skin,
and all forms of chronic cutaneous disease are thereby increased.
Hence the extreme difficulty that is always found to attend the
treatment of skin disease in persons oppressed with business or
sorrow. If the indirect excitement afforded by brain to the nutri-
tive viscera produces aggravation of skin complaints, it may be
readily imagined that their direct excitement by food of a stimu-
lating kind is equally calculated to cause similar results ; and we
accordingly find that diet of different Kinds has a most marked
efiect on those complaint.s, and is, indeed, a very frequent and
sudden originator of them, as in the outbreak of nettle-rash finom
eating shell-fish, of pimples and* itching of the scalp from taking
tinegar, pepper^ almonds, &c.

SKIN DXSBASBS* 3S1

But aggravation aod suppression of skin disease vre also in
enced by agents applied directly to it. Variations of tempera*
ture, cold, dry, easterly winds, particles of dirt, the remdence o£
the moist or dry secretion of the morbid skin itself, friction oi
garments, &c., tend to aggravate the cutaneous disorder ; for they
all afibrd to the exhausted and distended blood-vessels of the skin
sufficient excitation to cause them to contract and then relax
again more than ever, thereby augmenting the exhaustion and
distension. Scratching an itching part acts in this way : whilst
you scratch, you stimulate the blood-vessels to contract and get
rid of their blood ; but your nails, and the stimulus they gave,
withdrawn, the vessels become more and more relaxed, until «ore-
ness takes the place of Uckmg, If an agent of a very stimulat-
ing character be applied to the chronic skin eruption, it may sa
completely rid the vessels of the skin of their blood as to cause
it to be thrown upon other parts, and those internal and impor«
tant ; and an irritation is' there and then set up which prevents
the return to the skin, whose malady is thus suppressed. In this
manner it is that divers washes, ointments and plasters set aside
the cutaneous only to raise up far more serious disease within ;
many a lady's life has been perilled, and some actually lost, by
these attempts to remedy a pimpled or a florid face.

This rationale of the leading facts of skin diseases was neees*
sary, in order to the proper understanding of the philosophy of
the water treatment as applied to them. That treatment proceeds
upon the fact, that nature throws skin disease out in order to
save her nobler parts. To reduce the irritation of those parts on-
the one hand, and, on the other, to rouse them to further e£Ebrt»
directed towards the skin, are the principal aims and results of
the water cure. The wet-sheet packing is the great agent in the
majority of the diseases under consideration ; it peculiarly re-
duces internal irritation, is soothing to the external irritation, and
at the same time renders the skin the particular point on which
that within would be thrown. Thus favoring the evolution of
the internal disorder, the first effect of the application of the
water treatment is to increase the skin complaint. For this the
patient must look in undertaking it, and without it he may be as.
sored that he is not making much progress. It is an imitation
and improvement on nature ; she makes the SKin disease fer a
salutary purpose, and we increase it for the same purpose. Bat
a time comes when there is less and less mtemal irritation ti

t88 SKtlf DI8SA8S8.

ihrow oiit ; Uien does the external one begin to hde also. Go oo
steadily with the treatment and both are exUngvished, not tran9^
f erred; an eruption once disappearing from water treatment
never re-appears, until you apply the morbid causes to the oucem
again, for it tears up the root of the skin complaint. There are
some skin complaints occurring in persons of scrofulous habit of
body, such as scaly tetter (psoriasis) and dandruff (pityriasis)
which require an occasional sweating ; but the wet-sheet packing
may be said to be the principal general remedy in all skin com-
plaints. Of course, as these last are only symptoms of intern^
derangement, other means applicable for the restoration of the'
general health are necessary, such as sitz baths, occasionally the
douche, the dripping sheet, dec. In most of them also, copious
water drinking is recommendable, where the circulation in the
head is calm ; for water drinking has a vast influence in deter-
mining visceral irritation towards the surface.

Local applications are necessary where they can possibly be
maintained over the part. The temperature of the compress,
however, varies with the amount of itching or soreness ; great
itohing requiring cold, frequently changed ; and great soreness,
which is generally subsequent to the itohing, requiring tepid com-
presses. Warm fomentations also are required when there is a
mingling of itohing, tingling heat, and soreness, as in chrome ery*
sipelas. In moist tetter {impetigo) the itching and soreness fire-*
quently alternate, and the local m^ans must vary accordingly.
These local means show very strongly the excessive secretion
of the mucus, which dried, constitutes the outermost layer, o%
what we ordinarily call the skin ; for the compresses constantly
give out, when washed, after being used for a few hours, matter
which renders turbid the water in which they are placed. And
this excessive secretion of outer or unorganized skin speaks for the
excessive accumulation of blood in the tmder or true skin, and for
the activity of secretion consequent on that accumulation.

The diet is important in skin diseases. In the majority of cases,
abstinence from, or a very small proportion of, animal food is de-
sirable, farinaceous matters being substituted. But reference
must always be had to the condition of the stomach and other di-
gestive organs, whether they be in a state of nervous or mucous
indigestion; the general rules for which will be found under
^hose heads. All condiments are exceptionable ; even salt should

8X1N DtSBAStS.

be taken with extreme care ; and all beverage, MtTe water, dioiild
be avoided.

The clothing should by no means be always light, as is often
supposed to be inculcated by the water treatment. Highly senst.
tive as the morbid skin is to variations of temperature— to winds
and electric changes of atmosphere, it is often necessary to have
some non-conductor of heat and electricity, such as flannel, next
to the morbid surface, to shield it from distressing excitement,
and maintain uniformity of sensation, as nearly as it is possible
to do so. Indeed, one of the reasons for the beneficial operation
of the compresses is to be found in the uniform sensation and
soothing which they cause and maintain on the irritated surface.
But much will depend, in this matter, on the general capabilities
of the individual, the reactive energy, the digestive activity, the
nervous susceptibility, &c. ; for skin disease occurs in persons of
the most opposite constitutional powers, in the poor-blooded as well
as the full-blooded.

As the skin maintains an exquisite sympathy with internal irri.
tations, both of the digestive organs and the brain, and is, more-
over; directly and constantly exposed to the air and its various

• states of temperature and electricity, it will surprise no one to
learn that, although. the water treatment is almost infallible in the
cure of its diseases, the duration of the treatment is, under the
most favorable circumstances, long : the rather as all those likely
to fall under its operation are of long standing. Of course, the
length of treatment bears a proportion to the standing of the ma-

^dy. It also is much influenced by the mental condition of the
patient : care and sorrow inveterating the disease and prolonging
its cure. In all cases the patient must .expect to have it rendered
much more severe and sore, though itchingj if it exists, is always
allayed or converted, as I have said, into soreness. When skin
disease comes on in old age, or is coincident with fulness of the
head, it is usual to consider how far it is advisable to interfere
with it, Nature in both instances oflen making on the skin a diver-
sion in favor of some internal vital organ. But with the water
treatment this objection does not hold, inasmuch as it actually,
for a time, increases that diversion and ultimately gets rid of the
internal cause of it. Accordingly, I have treated, and should
not hesitate always to treat, cutaneous disorders in both these
cases.

The principle of treatment in all skin diseases being the sain%
14

wo 8XIN DISBAUS.

the details are also very similar, the differenees being 1911)7 sm^
as are rendered necessary by age, constitution, &c., and are in
degree alone. Some persons require and bear a more rapid and
continuous application of the means, whilst the frames of others
become fatigued, or too much excited by them, and they accord-
ingly require to be spread over a longer period or intermitted from
time to time. All this is a matter of observation, experience and
tact, and cannot well be conveyed in writing. I shall, therefore,
only state the chronic skin diseases which I have treated with
water, and the Tesults.

1. Chronic Erysipelas in a person of fifty-two years : had existed
eight or nine months about the left leg and loins. Became very sore,
and exuded purulent matter after five weeks of the compress : was cured
in eight weeks : looseness of the bowels during the last two weeks of
treatmeot.

2. Another case of the same disease in a lady forty-nine years of age :
had existed two years with variations of intensity, over the throat and
chest : \^SiS cured in eleven weeks without any critical action, either
local or general : bat became very sore during the treatment. ^

3. Scaly Tetter (Psoriasis) in a man forty years of age, in whom it
had existed upwards of twelve years, and had possession of the greatest
pait of his body (Psoriasis diffusa). With occasional intenoissions and
relaxations of treatment, it required ten months to cure this case.
Wherever a compress could be applied, the skin gave out enormous
quantities of creamy stuff which was regularly scraped ofl^ and the pack-
ing sheet always made the water exceedingly turbidi After some months
of this, the skin became sore, and gave out very little limpid fluid. This
ceased, and then the skin took to sweating on the smallest exertic^
Tonic means stopped this, and the patient was well.

Scaly tetter is one of the most frequent skin complaints presented for
treatment : I have treated seven other cases of it, but none of such long
standing as the above.

4. Dandrif (Pityriasis), I have cured one case of Red Dandriff (P.
rubra) in a man sixty-five years of age : and two cases of Variegated
Dandriff^ (P, versicolor), one of them of a man of forty-seven years, and
the other of a man thirty-five years old. The first of these cases required
four months, the second three months and a half, and the third four
months.

5. Itchy Rash (Prurigo), one case of the Prurigo pudendi mvJiehriSy
cured in two months. The patient was sixty-one years old, and had
great irritation of stomach, with much mental distress : she got better
much sooner than I expected.

• §* Shingles (Harpes Zoster) in a youth of twecty yean. Wet-^heel

SKIN DI8BASB8. Ml

packing and eopions water drinking, caiued vomitiiig and Imrmniittir

relief of this painful eruption in twelve days.

Skin disease is one of the opprohria mediciruB, but from the ex-
perience I have had of the effect of the water cure upon it, I
cannot doubt that it will no longer remain so, if medical practi-
tioners will cease to countenance in the community the prejudice
which exists regarding the repulsion of eruptions from the appli-
cation of cold water. If I wished to strike in a skin complaint, I
should give the patient a succession of strong purgative doses,
and apply a stimulating ointment or lotion to the diseased skin :
the' latter would soon be exchanged for some internal malady, but
would be said to be cured ! And such, indeed, is the ordinary
cure of skin diseases ! But the true history of their origin and
progress forbids us from crediting such cures. The water treat-
ment, proceeding on the natural indications of this class of dis-
eases, affords the only opportunity for a natural and pemumeni
removal of them, and it ought to be employed in them by all who
would gain health for their patients and credit for themselves.
A vast field of usefulness is open in that direction.

PART III.

PRINCIPLES AND DETAILS OP THE WATER
TREATMENT OP CHRONIC DISEASE.

**irv*»""ii^i^VT.ru~iri fLw^

CHAPTER I.

GENERAL REMARKS ON THE ACTION OF THE WATER
TREATMENT.

The Water Cure acts by calling the power of Nature into play, and assxste
Nature by imitating her— Negative means of the Water Cure— Particu-
lar seat of the natural restorative power — ^Positive means of the Water
Cure— Their action on the nutritive nerves of the skin— Thence upon
the viscera, both direct] y and indirectly through the brain — Consequences
of this action on the viscera— Their efforts at self-restoration leading to
better circulation of blood— Better blood a consequence of better circu-
lation — Change of the mass of blood by water drinking, air, and exercise
—Triple result of the action of all the means of the Water Cure-
Rationale of critical action — ^Violent use of the Water Cure unnecessary
for cure.

It is not my purpose to prolong the present part of this volume
beyond what is necessary for ja succinct account of the mode in
which the water cure afiects the organization generally, and the
advantages it has over other plans of treatment in certain diseases.
This will form the subject of the present chapter. And another
chapter will be occupied with an account of the probable action
of each of the processes of which the water cure is composed,
and with the equally important subjects of diet and exercise. In
doing this I shall carefully avoid the rhapsodical and exaggerated
stuff which has too often been applied to a subject of serious im-
port, since it implicates the life and the physical and moral oom*
fi^rt of the large oonomunity of invalids.

204 ICTIOlf OF TU£ WATER TSEATM£NT

1. The water cure is essentially a hygienic mode of treatment :
that is to say, its appliances are such as belong to agents which
are playing upon the body in all states of health. Food, air, the
stimulus of the Will as operating in muscular exercise of the
body, the stimulus of the Thought as operating in exercise of the
mind, the stimulus of wajer taken internally as operating on the
chemico-yital changes of the frame generally, and used externally
as augmenting those changes in the vast and highly sentient
surfilc^ of the skin in particuIaT,-r-these are the means by which,
in as much as they are at all times necessary to the heaUhy
existence of the body, the water treatment proposes to cure its
diseased existence* Forming part of the ordinary and inevitable
sustainers of life, they have been called natural remedies, in
contradistinction to those which, from their non-necessity under
ordinary circumstances, have been called non-natural. Hence
the water treatment includes and relies upon the regulation of diet
or of the primary nutritive organs, of air or of the secondary
nutritive organs, of the mind in thought and action or of the
animal nervous system, and of the great act of nutrition carried on
in the extreme blood-vessels, and increased or decreased accord-
ing to the application of water.

But this reliance on such means implies reliance on the organs
alluded to. It supposes a seif-restorative power in them ; a power
which, within certain limits, is capable, and is alone capable of
curing any disease, provided the organs he placed in the best pos-
sible circumstasices for exercising it. It were impossible in this
place to enumerate all the instances which establish beyond a
doubt the existence of such a power in the b<.>dy, and to name
fever as one great example of its exercise is suiHcient. Writers
on the water cure have spoken of this power as a discovery of
their own ; but great names in medicine have maintained its ex-
istence, and in great part relied upon it, from the earliest times.
Hippocrates, although he administered physic, constantly insists
on the necessity of avoiding it until the body has well concocted
its humors ; that is to say, until the organs have made show of
ihe direction by which they are about to relieve themselves ; and
the modern Hippocrates, Sydenham, is ever directing the prac-
titioner to observe, to watch, to guide the disease, but not to med-
. die with the natural progress of it. One of the most learned of
living medical: writers says : " When healthy properties are im-
paired, we know no agent by which they can be directly retftor^ ;

m CHKOHIC DISEASE. 2W^/

when vital action is peryerted or deranged, we possess no i
of immediately rectifying it, but must be satisfied with using those
means under which it is most likely to rectify itself." This truth
was published,* and quoted by me in my " Simple Treatment of
Disease," before the water treatment was at all known in this
country ; and on it was based the discontent with the usual mode
of medicinal treatment, and the belief that it did more harm than
good in disease, which I there expressed. In fact, by it the body
is placed in the most un-natural position, and its efforts at relief
constantly thwarted. Disease, which is quite as natural a process
as health, is not allowed to go on as nature would ; the internal
organs, whose morbid action alone can cause death, are made the
arena for all sorts of conflicting and inflicting medicinal stimu-
lants ; and, between the action which these excite and that which
originally existed, their vitality fails, their efforts towards restora-
tion flag, and their functions are at length extinguished. I have
already shown, in a former part of this volume (page 39 ei seq.),
how, when this meddling treatmant does not kill, it seldom fails
to convert acute into chronic disease. Nothing can be more fla-
grant than the want of sound physiological knowledge displayed
in the employment of this ultra drug treatment. Its vast defi-
ciencies as a curative plan, its actual opposition to the curative
attempts of the organs, its coarseness, and its inconsistencies, have
obliged the better part of the medical profession to abjure this
fearful system of active drugging, to trust more and almost en-
tirely to Nature, and to help her only when she seems inadequate
for the task of self- restoration. But whilst enlightened men, such
as Sir James Clarke, Dr. Forbes, Dr. Watson, and others,' see
clearly and act skilfully on this great truth of the body's renewal
of health,, it is still " a shut book and a sealed leaf" to the herd of
surgeon-apothecaries constituting the mass of the profession, who
are sent forth, with a miserable modicum of physiological know-
ledge, but an extreme subtlety in the various ways of mixing.
physic, to propagate chronic disease and perpetuate medical
ignorance, rashness, and charlatanism. Spite, however, of this
mass of ignorance and narrow prejudice, the evil has become so
shameful, that even the leading literary organ of drug medication
has been obliged to lay bare the disastrous consequences that have
all along attended its practice in this country. In a long article |

• In «« Elements of the Practice of Physic." By Dr. Craigie. Introdae-
tion»4>. 36, published in 1837.

Mt ACnOH 07 THS WATKE TEBATICBNT

pabUshed in the January number of the '* Britieh and Foreign
Quarterly Journal/' Dr. Forbrs has told some hard truths oon.
ceming drug medication, which must be highly unpalatable to
the hybrid prescribers and vendors of physic, who call themselves
professional men. After a somewhat one-sided review of homcs^
Cpaihy, he falls foul of aHopathyy unsparingly denounces the mis-
chief it has efiected, and suggests a reformation of medical art by
the re-introduction of a third power — *< the power of natubb *
Yes,

*< Naturam expellas furca tamen usque recurret"

Not all the sordid interests involved in the sale of drugs can
prevent the intrusion of the omnipotent truth, that in the body itself
it to he found the agent of restoration, and that Art only helps the
hody m that agency. To this confession the very expositor of the
spurious art of drugging (for it does not merit the name of art) is
compelled to come ; to the confession, 1st, " that in a large pro-
portion of the cases treated by allopathic physicians, the disease
is cured by Nature and not by them ; 2d, that in a lesser, but
gtill not a small proportion, the disease is cured by Nature in spite
of them ; in other words, their interference opposing, instead of a^s-
sisting the cure; and 3d, that, consequently, in a considerable
proportion of diseases it would fare as well, or better, with patients,
if all remedies, especially drugs, were abandoned."*

To the power of Nature, then, that is, to the vital energy of
the organs, the scientific practitioner of the water treatment looks
in the first instance. He does not for a moment suppose that his
processes have anything in them which, of itself, shall effect a
healthful change in the body. True, it has been advanced that
water has a specific effect on the body in the same way that
fuinme has ; but this is sheer nonsense, and strongly indicates
ignorance of the principles of the water cure on the part of the
propounder. When I say that the wet sheet reduces the pulse,
I mean that it places the diseased organs in a condition to get
rid of their irritative state, and thus to send a smaller amount of
sympathetic excitement to the heart* When I say that large
water drinking excites the pulse and circulation, I mean that it
places the organs generally in a condition more speedily to bring
about those chemico-vital changes which are dependent on the
presence of the blood, which is therefore more rapidly circulated.

*Loc. eit,p. 357.

Of CHBOHiC BOEm. ' Ml

Ijfben I say that the sits bath tends to open the bowehi, I
that it puts the lower bowels in a condition to receive more Uood
^ into their secreting surface, by placing other parts — the stomach,
Ufer,*brain, o( spinal cord, in a condition to get rid of their irri.
tative state. In fact, all the results of water treatment which
we behold are secondary ; the vis vita is primarily acted on by
the means employed, and it induces the phenomenal consequences
we behold.

11. This sound basis of treatment, namely, that the organic
energy of the body is to cure its disease, being taken, it is ne- .
oessary to remember that that energy may be deficient for the
purpose, and may thus tend towards destruction or organic dis-
eiase rather than cure. Hence the necessity of Art,— of Art
which seconds the objects of Nature and aids its flagging ener-
gies, but iii no case runs athwart them. In chronic disease this
necessity especially arises, from the circumstance that the organs,
29 their intimate and minute action (see Psut I., page 14), are
in the extremity of feebleness, and make but small efforts of
self-restoration ; chronic disease, in fact, almost always tending
towards organic, incurable disease, when left to itself. In say-
tng that Nature is the only curative power, the very presence of
lUsease implies that that power is deteriorated and requires aid.
The water cure afibrds it, and is one of the best instances of
Art applied only in seconding the indications of Nature. Testi-
mony to this effect is given by the leading journal of drug me-
dication, already quoted. Db. Fokbes there says ; — " This mode
of treating diseases (Hydropathy) is unquestionably far from
inert, and most opposed to the cure of diseases by the undisturbed
processes of Nature. It in fact^ perhaps ^ affords the very best evU
dence we possess of the curative power of Art, and is, unquesttona-
hly, when raUonallyreguUUedt ^ w,ost effective mode of treatment in
many diseases. Still, it puts in a striking light, if not exactly
the curative powers of nature, at least the possibility, nay, fa-
cility, with which all the ordinary instruments of medical cure,
drugs, may be dispensed with. If so many and such various
diseases get well entirely without drugs, under one special mode
of treatment, is it not more than probable that a treatment con-
sisting almpst exclusively of drugs may be often of non-efifect,
sometimes of injurious efiect ?"* Such admissions in the pages
of such a periodical are strongly significant of the growing ooQ'

• *.Loe. eit, page 204.

14*

•MS ACTION or THB WATBE TREATMSNT

▼kCion in the high places of drug medication that the wa^r cars
is not, as it was there loudly and unsparingly denounced, a sysm
tematic quackery, but that it is the true medical aet, — ^the Art
which watches Nature's tendencies, and aids her in her necessity*
III. This aid is given in' a negative and in a positive manner.
The negcUive means consist in the withdrawal of the predisposing
and exciting causes. In this there is no compromise ; there can
be none. If there be irritation of the stomach inducing costive-
ness, it is absurd to expect the bowels to act whilst the aperient
medicine is keeping up that irritation, apply what positive treat-
ment you may. If there be congestive or apoplectic fulness of
the head, all the positive treatment in the world will not avail so
long as huge feeding, stimulating drinks, tobacco-smoking, vene-
real excesses, &;c., are persevered in. In the first part of this
work I have endeavored to show the very minute yet highly irri-
tative action of a part affected with chronic disease, how in their
extreme organic feebleness the ultimate blood-vessels are more than
usually sensitive ; how then is this mingled sensitiveness and fee-
bleness to be remedied, so long as irritants, however small and how-
ever applied, be permitted ? It cannot be ; and he who allows his
patients to persist in any such causes, understands nothing of the
water cure or nothing of honesty. Practitioners of drug medica-
tion say that we, the professional adherents of the water plan,
<< may well cure patients, for we insist on certain abstinences in
diet, personal habits," &c., and that " these and not the water
recover them." The latter I will anon show to be incorrect ;
but the former is altogether true, and suggests the putting of the
question to the objectors, " Why do you not also insist ?" But
then, again, not much would be gained, so long as medicinal irri-
tants are maintained ; to forbid roasted meat, lest it should irritate
the stomach, and at the same time to administer a daily aperient
or tonic, is an ignorance or affectation that is scarcely compre-
hensible, although of daily occurrence. (See a curious instance
of this at page 102.) It would be foolish and dishonest to deny
Jiat the withdrawal of morbid causes to be found in diet, bad
personal habits, mental excitation, &c., forms a very important,
nay, indispensable portion of the water treatment, and that this
latter would be curtailed of the greater part of its usefulness with*
out it. Patients who have recourse to that treatment, must make
up their minds to drop various darling weaknesses or else to le*
••ive but small benefit.

XV Gssomc

The cessation from taking drugs is a striking item in the nega-
tive means, i.e. in the withdrawal of causes. To it is verj much
owing the great and immediate relief which most patients under
the water treatment experience in the first week or two ; the ab-
sence of the. daily irritant leaving the viscera at rest, instead of
rousing in them morbid excitement, which is reverberated upon
the animal nervous system, inducing all manner of diseased sen-

. sations, and especially calling the attention of the brain to what
is going on in the viscera. Without this withdrawal, no lasting
benefit is to be obtained from the water treatment. It may be ex-
pedient to treat a case with drugs alone or with water alone ; but
to say that chronic disease can be cured by a mixed treatment of
water and drugs is a ridiculous contradiction, or an interested
compromise ; a net, in short, thrown to catch two extensive seats
of persons, the simple and the prejudiced : an excuse for gleaning
from all fields. Imagine a patient who, having tried all kinds oi .
drugs, has added the irritation they produce to that of the origi-
nal malady, placing himself under a medical treatment which,
while it professes to reduce the irritation arising from both sources,
at the same time keeps alive both ; so that the morning wet-sheet
packing takes off the visceral disorder of the previous day's
dosing, and even prepares the body to be more keenly irritated
by the dosing of the current day ! This is like emptying the
right-hand pocket to pay the lefl : the person carries just the
same amount : at best the patient is in statu quo — more probably
in stulu jpejori. I speak not now of the modicum of water appli-
cations which have always been more or less employed by medi-
cal practitioners, such as partial spongings, short hip baths, ^c«,
but of the systematic employment of the various processes which
have been introduced of late years under the name of the " Wa-
ter Cure ;" and I- maintain that a combination of that treatment
with the administration of drugs for the purposes of curCy is alto-
gether fallacious, and an error by which the patient, at least, must
suffer. Nor is this a mere assertion of doctrine ; on three or four
occasions I have been persuaded to adopt such a combined plant
and have soon had to abandon it at the request of the patients
themselves, who found that medicines administered whilst the

,body is under the operation of the water treatment excite a much
more- intolerable irritation even than they did previously. They
who profess to use both means are scarcely authorized to attri-
bute the results of their treatment to the water Qrfteniy j^prfU

§tO ACTION Of < «n WATBft TtSATMBlf T

«ftll UM^mselves pfo&ssors of that fiystem ; and their combination
of 4rag8, Ueeding, wet*sheet packing, douching, &c., is infinitely
more dangerous than simple medication by drugs** And this

• will be disoovered before long.

The withdrawal of the mind from harassing caTQS and ocoupa-
tioiis is another of the negative means included in the water treat-
ment of chronic disease. That form of disease has always existed
sufficiently long to involve the brain more or less in irritation.
Upon the brain, thus prepared, circumstances of disagreeable and
painful character fall with double intensity and exasperate its
irritation, which is then passed on to the nutritive viscera, aug-
menting their disorder. If such circumstances can be withdrawn,
the physician has only to deal with the chronic visceral irritatv!>n,
which he may subdue when the brain is quiet, but which he could
not touch so long: as that organ perpetually added fuel to the
flame. Moreover, this comparative freedom of the brain • from
excitement is required in the water treatment, because the ejects
of that treatment are brought about through the instrumentality

. of the nervous system, of which the brain is one of the great cen-
tres. If it be oppressed with care, and be made to labor exceed-
ingly at the same time, for the restoration of the body, the chances
are strongly in favor of its breaking down between the ^wo loads ;
and I have seen an instance of this. Therefore let no one attempt
the systematic water treatment who is unwilling or unable to rid

• In all that I have put forth concerning drug medication, I wish it to be
nnderstood that I am speaking of its application for the cure of chronic
disorder. As I have stated in the text, none but the less educated mem-
ber^of the profession think now-^i-days of dosing for such disorder. Most
of the class of physicians give medicine in small quantities, and trust
more to the operation of natural means, diet, air, habits of life, &c. Ne-
vertheless, they cannot therewith cure the great majority of chronic
diseases ; and the fault is in the instruments with which they work. But
cases will always occur in which it is at least expedient to employ drugs ;
and it is absurd to suppose they can ever.be entirely dispensed with. A
strong man gets bilious, but is obliged to continue his occupation ; let him
take t\v6 or three grains of blue pill, followed by an aperient draught, abstain
from animal food for twenty-four or forty-eight hours, and he will be well
without ceasing from his vocation, and without evil results. The evil lies
in making no change of diet when under, and for some time after, the ir-
ritation of the drug, and in the strong temptation to reiterate the causes
when the effects can be so readily disposed of. Then begins the abiise of
the medicine, for which, in the majority of instances, both patient and
practitioner are to olame. At the end of all this comes chronic diMBse*
%riiieh all tbe drugs in the world cannot euiB.

oi cmaonK BinAMt. .Ml

(iknarif, for the time being, of business and its botberatfoos, in.
eluding the daily score of *< esteemed favors'' from correspon-
dents : he will assuredly get more harm than good under such
circumstances. Neither, when grief is doing its sad work, is
there any prospect of improvement to chronic disease from the
water cure ; *'- mens agitat molem," and it is not safe to agitate
the body in two ways at once. I have seen a sudden invasion
of nonsensical love arrest the improving progress of a neuralgic
case, which, under the water treatment, was advancing steadily
towards complete recovery. The water could not wash away the
feeling, but rather seemed to render it more painful and hdicu-
lous:

" Ah mihi ! quod nulUs amor est medicafiilis aquia**

The worst of the affair was, that the neuralgia was more painful
too, and did not wear out, although the amorous folly did.

For the same reason as that given above, it is essential to with-
draw the mind from the excitements of gaiety and its usual con-
comitants, in this country, of hot rooms, strong lights, &c. We
are told that water patients (some in scarlet fever, too!) hold
large dancing parties at Graefenberg, and all get quite well. If
' so, there must be something in the air of the place which enables
persons to resist the ordinary operation of causes which, nearer
home, certainly deteriorate the patient's condition whilst under
the action of the water treatment. I have seen such consequences
again and again. But "distance lends beauty to the scene;"
Gr&efenberg is 800 miles off, and travellers must not go so far to
see ordinary occurrences. Be this as it may, there can be no
question that, on account of the temptations to gaiety, the racket,
noise, and distractions of large towns, the

« Fumum et opes strepitumque Romae,"

the water treatment of chronic maladies cannot be successfully
practised there. It has been tried and utterly failed in three
large towns of England, namely, Liverpool, Bath, and Chelten-
ham ; and I believe a similar result has obtained in various con-
tinental towns. In rural places all these drawbacks are avoided,
and the quietude alone is an important adjuvant to the negative
txeatment of persons whose sensations have been rendered exqui-
•itel^ acute by previous pnorbid causes, and whose organs are now

W3 ACTION OP tffS WXtttL TKSATMSICT

lo be roused by the water system to an attempt at their self-resto-
ration. So necessary do I think this consideration of locality^
that even the proximity of a large, dissipated town is, in my be-
lief, ol^ectionable. Never did I know a patient who ran up to
London for two or three days return so well as when he left
Malvern.

So much for the negative means of the water cure.

The positive means of the. hygienic water treatment include all
the applications of water, from the compress and foot bath up to
the sweating process and the douche, the taking of water intet.
nally, food, 'exercise, and clothing. As the detailed consideraticm
of these will fall to a subsequent chapter, I only allude to them
here as agents wiiich, whilst the negative means tend to disem.
barrass the morbid organs, tend to bring them into positive and
active eflR>rt for the recovery of their healthy functions. Nature,
entirely freed from the unwholesome operation of diet, drugs,
mental cares, &c., would certainly be left in the best possible
position for re-assuming her healthy actions, and in very many
slighter instances she would do so. I constantly have patients
applying to me, to whom I say, " You would recover by retiring
to a farm-house, having care of your diet, rising early, taking
appropriate exercise, breathing abundant pure air, &c. ; and this
would require to be continued for eighteen or twenty-four months.
What the water treatment can do for you is to curtail that
period by one-half or two-thirds." And so it is in these slighter
cases ; withdraw irritations and bring neglected organs into more
active play, and you lend a helping hand to those that are over-
worked and morbid. Good food applied to the stomach helps to
make good blood ; pure air abundantly applied to the lungs helps
to perfect that blood ; the same air applied to the skin draws that
blood towards the outer surface, thereby relieving the inner visce-
ral surface; exercise and early rising promote the circulation-
and waste of that blood, thereby ridding the frame of a diseased
fluid, at the same time that better digestion is forming a better
fluid, which at length brings about healthy nutrition : such is the
process by which retirement and country life renew the jaded and
chronically diseased frame.

Now the appliances of the water cure operate in a precisely
similar manner, but much more energetically, and therefore
more speedily. The appetite, rendered keen by the ensemble of
the plan pursaed, and eapeoially by tiM water drinking, lM4»tB-

m oBftONio ftfaosiiflB. MS

die digestion of good hoAy for the processes all tend to the redue-
tbn of irritation in the digestive organs ; the life in the open air
perfects the hlood formed from the food ; all the processes tend to
draw that hlood towards the exterior surface and relieve the inter-
nal organs ; the water drinking and exercise increase the chemico-
vital changes of the hlood which waste it ; and, as the old morbid
fluid dissipates, improved digestion is making a better, which is
to bring about a healthier nutrition of the frame. It will be seen
that the parallel is complete : and as the means of the water cure
are only, as it were, an exaggeration and systemization of those
to be found in the natural agents — food, air, and so forth, it may
very properly be denominated the hygienic water treatment.
These positive means are only imitations and improvements of
those employed in the purely natural restoration of the body ; and
they thus fulfil the highest aim of Art — ^the imitation of Nature.
No plan of treatment which I have ever heard of so completely
keeps this in view as the water cure ; it aids the body by the
very same agents that Nature uses, and in such a manner as
never to interfere with her tendencies towards restoration of
health. When the body is thus only aided in its own efforts by its
own appropriate agents, the best possible ground is afiR>rded for
trusting in the permanency of the cure which itself effects. No
cure can be complete or permanent which is not the result of the
body's own efforts, and which is wrought by artificial and forcing
agents.

When, therefore, time is an important matter, and some trouble
is not considered (for the water treatment does imply pains-tak-
ing), there is much gain in having recourse to the watpr cure,
rather than to the mere life of simplicity and retirement. It has
been suggested, that a month of its employment af^er the ex-
haustion consequent on a period of dissipation or occupation,
would be more than an equivalent for three or four months of
travelling, and similar healthful stimulants ; and there is no
doubt that such is the fact. Besides, when a man travels, or is
even fixed for a period in one place, he is lefl to his own devices
and exposed to temptations, the gratification of which wars against
the renewal of health ; whereas the water cure fives him to cer-
tain wholesome rules and habits, that are necessary parts of the
hygienic regime under whit.i he is. It is too true, that visiting
the populous watering places, such as Cheltenham, Bath, or
LMoungton, << for the benefit of health," is very often only •

i/04 .' ACTioif otnuE wMfm^mBATUxsn

ckmxige from one sc^ie of dissipBlion to anotha?^ taii4 that^^lk^
change alone enfibles tlie body to bear the dUsipatitm ; acapaU
iity which is mistaken for permanent restoration*

The more grave degrees of cbronio disorder, however, no pe-
riod of'retirenienty country life and air, or cJucbOge, will suffice to
remove. The orgfmic powers by which the ^salutary e^rts of
the frame are made, are far too deteriorated to be roused to.suoh
efforts by the ordinary operation of those ordinary natural agents.
Of this kind is the great majority of the cases which seek aid
from the- water treatment. The lower the organic strength, the
greater the amount of natural stimulus required to bring it iato
play ; and the concentration of such stimulus exhibited in the
various processes of the treatment in question, usually efl^ots
what the long-continued trial of quietude and air had failed to
procure. There is another reason for this. Numbers of my
patients, previously to visiting Malvern, had taken voyages,
changed residence, and so forth, but had not ceased to take medi-
cine, and had only changed from one kind to another. Nor
eoiUd they, under those bare circumstances ; the drugs were to
their languid organs a means of artificial stimulus, for which the
natural stimulants were not sufficiently strong to prove a substi-
tute ; and accordingly they continued to increase the feebleness
of the organs by the drugs on -the one hand, whilst, on the other,
they were in vain exposing themselves to the action of natural
remedies, which, without the drugging, would not have sufficed
to kindle or sustain the organic energies, but in conjunction with
drugging were utterly neutralized, the disease being allowed to
go from bad to worse. Yet these patients rarely fail to recover
under the water cure, becaase they find in it both a sufficient
amount of natural stimulus to rouse the organs, and a substitute
for the artificial stimulus of drugs ; the withdrawal of which,
therefore, is not attended with the inconvenience it otherwise
would be. This is a hard thing to be believed by those minds,
lay or professional, which connect inseparably medication with
drugging, and know of no remedies save those of the Pharma-
copoeia. It is not a whit the less true, notwithstanding : the
water cure does possess positive appliances, by which the body
is enabled to bear with impunity the withdrawal, immediate and
complete, of all artificial stimulants, medicinal and dietetic ; -and
juit only so, by which the self-restorative posver of the oi^^ans la

m CBIORIC DUBA81. IM'

nmed far more effectually and permaoently than those stimtt*
lants could ever do.

IV. The water cure, then, producing its effects by liberating
the organs from causes of disease, and by aiding them, when thus
liberated, in their attempted stru^le for restoration, we have next
to inquire what power of the organs it is which is set at liberty to
make the attempt in question. Physiological research leaves no
doubt on this point. All the causes of health as well as disease
infringe,, in the first instance, on the irritahUUy of the body, as
represented by the nutritive or ganglionic, or visceral system of
nerves. (See Chapter I. of this volume.) No organ or part of
an organ can be diseased without diseased action on the part of
its nutritive nerves. A certain amount of stimulation applied to
them produces the phenomena of healthy Ufe in any part; a
further amount causes the phenomena of excessive hfe, to be fol-
lowed, as certainly as fatigue follows extreme labor, by the
phenomena of dimimshed or exhausted Ufe. The connection of
this nervous system with the blood circulation has been stated at
length in the early portions of this work ; and it is only necessary
here to recal that, wherever there is exhaustion of the nutritive
nervous energy of an organ, there is excess of blood in the minute
blood-vessels, that energy being insufficient to afibrd to the blood-
vessels the power of passing on the blood they contain. In an
inflamed eye, we behold vessels distended with blood: those
vessels cannot pass it on because their ganglionic nerves, after
having been violently excited by a cold air, it may be, have gone
to the other extreme of feebleness, so much so as to be unable to
give the vessels contractile energy enough to throw the blood out
oC them. Hence, excess of blood and deficiency of ntUriUve nervous
energy constiiiUe the essential of diseased action of a part.

But when an organ is thus situated — ^that is, with too much
blood and too little nutritive enei^y— other organs come, in con-
sequence, to be conversely situated. We have a striking instance
of this in dropsy of the belly ; the large surface of membrane (tlie
peritoneum) in this state of vascular relaxation, increased blood
and decreased nutritive nervous power, causes vascular conircuitionf
decreased quantity of blood, and increased nutritive nervous power
in the kidneys (hence the decrease of urine) ; in the skin (hence
the paleness and coldness of it) ; of the mucous membrane of the
ii]K)uth and throat (hence the dryness and thirst); and of the
muoous membrane of the colon (hence the constipation). Blood

MO ACTION OV Tax WATBE TftBATMBNT

being phut in the dropsically inflamed part, is minus in other pvtin
And a similar arrangement obtains in all cases of obronic disor.
der ; there is always some organ or s&t of organs whose excessive
supply and retention of blood render them irritable in themselves,
and a source of organic irritation to other organs. From a corn
on the toe to an ulcer in the stomach, organic irritation, represented
by excess of blood and decrease of nutntive nervous energy,
obtains.

Now it has been shown, in the First Part of this volume, that
all nutrition in all the organs of the body depends upon the gan-
glionic nervous matter distributed to the minute blood-vessels of
each of them ; and that, as nerves composed of that matter are
everywhere, the organic or nutritive sympaMes (for they mean the
same) of parts are dependent on them. Further, it has been
shown that these nerves have their great central portion in the
viscera, and more especially in the viscera of the first digestion — •
the digestion of food. Hence it is that all organic irritations of
any organs are referred to this great centre ; and, according to
the state in which it is, or the amount of the shock they give it, is
the degree and duration of disease. If a man break his leg, the
organic irritation thereby produced in the leg is referred to the
visceral centre of all organic sensation ; if that centre be sound,
the leg will do well ; if not, it- will not, but a gangrenous or a
chronic inflammation of the limb will be established. If a man
catch cold in the -head, and is all sound in his nutritive nervous
centre at the digestive organs, the cold will soon disappear with-
out spreading ; but if he be not sound there, the lungs will be in
a delicate state in consequence, and the cold of the head will
extend to them, and cause chronic cough. Similar proofs may
be drawn from every sort of disease in any part of the body.
And the fact is beyond a doubt that, according to the condition of
the great organic nervous centre* in the primary nutritive viscera,
is the degree and duration of any diseased action elsewhere. So
long as a stomach will digest food well, no chronic disease can
come ; nor will it kill, until the stomach can no longer make
sufficient blood out of food for the waste of the frame.

It is upon the organic power enjoyed by every blood-vessel in ^
hody, a power represented by the ganglionic nervous system, and
having its centre in the viscera, that the water cure operates ; and
U is by it that the water cure produces its results. It is by the
UberetioD of this power from oppression, and the reeCeratioa of Hi

m CHltONIC DISEASK. S07

energy, that the water cure rouses in it those salutary effiMrts
whibh oonstitute the only means of obtaining fermanenl cure.

V. The condition of the viscera, on which chronic disease de.
pends, is one of irritation or inflammation, oppression or con-
gestiem, and obstruction. In applying the water cure, it is ne-
cesBary to ascertain which of these states obtains. It has been
stated in the last paragraph (IV.), that when inflammation or
congestion exists in a part, it is to the detriment of the circulation
in some other parts. And so in the inflammatory or congestive
state of the viscera under consideration, all parts of the body are
deprived of the fit quantity of circulating blood save the part
chronically diseased (a rheumatic limb, for instance), and the
viscera, which make its disease chronic. In rheumatism, for
instance, there is gorged liver and stomach, and inflamed fibrous
sheaths ; but the circulation in the skin flags, the kidneys are
scanty in action, so are the bowels, &c. In other words, there is
a tndUdiMributum of blood, from deficient organic energy in the
viscera, to rid themselves of the excess they contain ; for, if they
can be made to do that, the chronic complaint ceases. This is
the case both when there is fulness and when there is Want of
blood in the system generally ; ibr, as has been already stated,
when* there is general deficiency of blood, Nature always centres
the little there is in the internal parts. The principal aim of the
water treatment in ohrbnic disease is, therefore, to procure a hetler
dietrilwHon of blood'. If there be bloodlessness as well, ihef&rma>-
tion of^ hhod is another chief aim, but always in connection with
its improved distribution; otherwise the blood made will augm&nt
the congestion of the viscera.

VI. Having ascertained whether the phase of viscerAl fulness
is that of irritation, inflammation, congestion, or obstruction, it is
expedient to act upon some of the organs which have been de-
prived of' their supply of blood, and whose nutrition has been
curtailed by the excess in the viscera. In all chronic diseases,
the ^A^ is especially aflTected in its nutritive energy. As blood
accumulates within, it diminishes outside; so that in very old
chronic maladies, there is not a particle of blood to be found in
the shrivelled, bloodless surface of the body. It is upon this sur-
face tliat the processes of the water cure are especially directed;
Endued in the healthy state with an enormous supply of blood
and ntrtritire nervous energy, and^ moreover, closely connected.
idtti thtf btiitiiind sfdnal cord by innuifterable nerves jpaoceeding-s

108 ACTION OF TBS WATBR TSIATKBNT

firom them, the condition of the ikin, as regards nutrition, is n*.
oessarily of vast importance to the rest of the eoonomy. Am'
this is more striking still, when it is considered as the sur&os
which receives the impression of all atmospheric changes, form»
a great excretory organ, and is the seat of a considerable portion
of the process of waste always going on. In chronic disease, all
these important functions are diminished or deranged. Deprived
of blood, but still deriving exquisite sensitiveness from the nerves
it receives from the brain and spinal cord, it retains its suscepti-
bility to all external circumstances without having blood enough,
and therefore nutritive power enough, to re-act upon and resist
them. For a like reason its action of excretion and waste is di-
minished. The organic sympathy which it has with the visoera
within, by means of ganglionic nerves, is disordered, and the
equilibrium between it and the mucous membranes, which are
the interrud skin, lost ; whilst by the net-work of animal nerves
it takes from the spinal cord and brain, it sends up to those oi^gans
the impression of every atmospheric agent, and receives from
them the impression of every mental process of perception,
thought and will. And be it remembered, that in chronic dis-
ease the nutrition of the brain is always more or less deranged,
and that the skin, therefore, receives impressions from a
disordered source.

Thus standing between the two great nervous centres, connect-
ed with the ganglionic centre by the nutritive nerves it possesses,
and with the brain and spinal cord by the animal nerves with
which it is so copiously supplied, it may readily be conceded,
that the system of treatment which makes the skin the surface on
which to produce its operations is, at least, no contracted one.
Acting upon the skin, we can affect powerfully or feebly the nu-
trition of the primary nutritive viscera, and of the brain and spi-
nal cord, &c. ; and, through them, the nutrition of the entire
organism. Being external and patent, we can ascertain the exact
amount of the result of the remedies ; and on this account, as
well as because the skin is not a primary or secondary nutritive
organ, and therefore does not immediately compromise exist-
ence, we know it to be the stxfest part for the application ot
means. Besides all which, it is, in chronic disease, the organ
whose blood circulation has been most seriously deteriorated by
the visceral congestion, and which, therefore, most urgently pre*
ients itself as that by which to re-establish the equilibrium.

IN CHBOMIC D1SBA8X.

Vn. The action of the water cure, then, is upon the gangU*
onic or nutritive nerves of the skin, connected with the great
ganglionic centre of the viscera, and upon its animal nerves, ccm-
nected with the brain and spinal cord (it being always kept in
mind that the brain and cord are, as far as their nutrition is con.
cemed, themselves masses of ganglionic nervous matter). As
the viscera are invariably diseased in chronic disorder, and as
the brain and spinal cord are the organs in which they the soon-
est excite morbid sympathies, this action upon the skin is adapted
to produce results upon both these great centres of chronic disease
at once, ani this without direct applicaiwn to either : an important
consideration. For it is by virtue of this that the water cure is
an artistical treatment which aids, but does not interfere with the
natural efforts of the body towards health. By the adaptation of
the means to the organic capabilities of the viscera and skin, J
am enabled to produce a certain amount of reaction in the blood
circulation of the skin^ For instance, I apply a dripping sheet
to. the skin of a patient, after ascertaining the condition of his
viscera ; by doing so, I excite the nutritive nerves of the skin,
and, by that, cause contraction of the blood-vessels of the sur-
face; contracting, they drive the little blood they may contain
out of them upon the viscera. If I have calculated well the pa-
tient's condition, this sudden invasion, of fresh blood will rouse
the viscera to efforts to get rid of it, and those efforts will be di-
rected towards the surface, whose vessels are most ready to
receive the blood ; and this will be the skin, since, after their
vehement contraction by the water applications, its vessels will
have fallen into exhaustion, relaxation, and consequent capability
of receiving blood. This process, repeated day after day, and
two or three times a day, and aided by the Impressions made by
other processes to be mentioned, at length re-establishes the blood
circulation of the skin ; and this re-establishment of blood in
the outer surface of the body, ensures the diminution of blood
in the inner surface of the body, the visceral mucous membranes,
and their nerves. But I have shown that all chronic disease con-
sists in irritation, inflammation, or congestion of the primary
nutritive viscera; in -other words, in excess of blood in them.*
Therefore, diminution of blood in them is cure of such disease ;
hnd permanent cure, because they have effected it by their own
e^rts. All that I have done is to apply a stimulus to a skin
which was bdow par in vitality, in order to rouse, sympatheticaUy^

310 ACTION OF THB WATBE TBSATMSNT

on inner paxt which was above par in vitality, and would be bet*
ter for sending some of its excessive blood to the skin which
wanted it.

All this supposes adaptation of the means to the organic ca-
pacity of the patient : this cannot be too much insisted upon. It
would all have been reversed had I, instead of the dripping sheet
alluded to, ordered a cold shallow bath. The stimulus of this
would have driven a larger quantity of blood from without inwards
than the yiscera would have organic power to resist and throw back
again ; it would therefore have remained in the viscera, increased
their blood, decreased that of the skin, and thus have inveterated
the chronic disorder. This shows strikingly the necessity for
professional nicety in the numerous cases where the vis viUz |s
materially impaired by the long-continued mal-distribution of
blood. It also shows the absurdity of treating all cases alike, or
nearly so, as is too often the fact with the gi-devant bath servants
and pseudo»doctors who pretend to practise the water cure.

So much ibr the direct nutritive sympathy between the gangli.
onic nerves of the skin and those of the viscera, which is brought
into active and healthful play by the water appliances to the
skin.

But these appliances also convey impressions from the skin to
the viscera indirectly, through the medium of the brain and spinal
cord, whose nerves are distributed in the texture of the skin. It
iis needless to repeat the rationale of this, the strict sympathy be-
tween the brain and viscera being sufficiently understood to
account for it. Still, it plays an important part in the action of
the water cure, and especially of those parts of it which are to^io
and stimulating, and have the result of removing obstinate con-
gestions and obstructions. The prolonged shallow bath, the
douche, and the sweating process, act very mtich by the stimulus
they excite in the cerebro-spinal system, and the communication
of that stimulus to the viscera. In a minor way, rubbing sheets
and foot baths edect the same, removing such temporary oonges*
*tions as are indicated by nervous headache, occasional giddiness,
&o. It is clear that such a power of acting on the brain should
be used with discretion, and only after accurate investigation of
its condition ; and I have spoken on this point in the section on
" Apoplectic Fulness of the Head," How this is to be done with*
out professional knowledge, I leave those to determine who tmat
ItoinsBlves to the guidance of the self-constituted practitioBWii

m cHEONic nissAss. 811

iUttded to in the last paragraph. It is the more necessary to be
precise on this matteri as it is^ in great measure, by the instru •
mentality of the cerebro-spinal system that the great changes
effected by the water cure are produced. So much is this the
case, that in many instances we are obliged to suspend or relax
the treatment in order to afford rest, for a time, to the nerves,
which give signals of distress in fidgetliness, broken sleep, im*
patience, and irritability, dec. Immediately previous to any cri-
tical action also, symptoms of this kind evidence the unusual ex-
citation and labor of the cerebro-spinal centre of nerves. Excita-
tion, indeed, of that centre communicates to the visceral ganglionic
nerves some of that power by which they are enabled to throw
off their chronic disorder ; and it will therefore be at the highest
when that disorder is nearest to its end. When in this state, —
that is, approaching a crisis,-— patients generally contract great
horror of all the baths and process^ which had previously pleased
them ; and this plainly because the applications to the skin add
to the excitement which they already experience, and which are
due to the state of the brain : there is a genuine instinct in the
horror they feel. If the treatment be scientifically and carefully
conducted, according to the organic state of each patient, the
whole of this action on the brain and spinal cord is perfectly easy
and perfectly safe ; but if all the persons be treated alike, that is
ignorance and quackery, and the water cure is not accountable for
its consequences.

Excitation, however, is not the only state of the cerebro-spinal
centre which the water treatment induces. Some of its processes,
such as hot fomentations to the stomach, the wet-sheet packing,
and the prolonged sitz bath, have a decidedly soothing effect on it ;
a sense of quietude, and even sleep, attending their employment.
These, accordingly, are the processes that apply to active irrita-
tions and inflammations rather than congestions and obstructions,
in which last th'ey oflen- do harm. They soothe the extremities
of the animal nerves that are distributed to the skin, and, jpro tantOj
removing irritation from their centre, the brain, this J atter send*
less excitation to the viscera, and thus the whole frame is quieted.
Part of this quieting of the viscera must, however, be attributed
to the operation of the soothing processes on the ganglionic nerves
of the skin directly communicated to the viscera, and without the
intervention of the brain ; for visceral irritations are oflen re-
moYed by them, without, at least, any appreciable alteration hi

]

dl3 ACTION or THE WATEK TREATMENT

the function of the hrain in the direction of quietude. Yet thiii
only applies to such visceral irritations as have not materially in-
volved the brain in their disorder ; if that organ plays a promi-
nent part in the morbid phenomena, the soothing processes are
certain to act upon it, and through it upon the viscera. Of the
rationale of these processes, I shall have occasion to speak here,
rfter.

VIII. Acting, therefore, upon the ganglionic nervous power
ol the exterior of the body by the production of excitement or
soothing, as the occasion may require, the water cure efiects a
change in the visceral or irdemal centre of that power. It has
been abundantly shown, in the course of this work, that the ex-
istence of chronic disease in any part is attributable to chronic
excess of blood in that visceral centre, an excess accompanied by
irritation or oppression of the ganglionic function there. By
operating, as has been said, upon the skin, the irritation in ques-
tion is soothed or the oppression relieved ; in other words, by ih$
diversion made upon the skin, the excess of blood in the viscera is
diminished, whilst the quantity of blood in the skin is increased.
And let it always be kept in mind, that this operation on the skin
means operation on the nutritive nerves of the skin, and that this
diminution of blood in the viscera is the result of an action which
this operation on the skin has enabled the centre of the nutritive
nervous system to commence, and which a continued operation
on the skin enables it to maintain ; that action being what is
called " a natural effort towards self -restoration"

In the manner in which this ofieration on the skin is com-
menged, in the tact with which it is maintainedyf-elaxed or pushed
according to each patient's position and power, consists the scien-
tific application of the water cure. It is easy enough to instruct
a patient to go on with the same processes fi>r a week or two, and
never see him meanwhile ; but such proceeding betrays igno.
ranee as well as indolence on the part of the practitioner. The
disagreeables which always attend the attempts of the viscera to
ight themselves may be materially diminished by accurate and
frequent observation of the progress of the treatment ; and even
although the event of cure might be the same without it, the
physician's duty is plainly to make it. ' I am aware that in some
water cure establishments, continental ones especially, the con
trary to this is inculcated and practised ; that the patients art
Kunulated, knocked about, and kept in an incessant state of ex.

dlemeiitand constimtioDal turmoil^ and indie end are cured ; but
this is what any one can do ; this is pure bap-hazard ; and, lastly,
this is not 8(tfe. Neither is it a whit more suoc^ful than the
more considerate and considered plan which is constantly adapt-
tng the applications to the state of the body, so as to avoid all
unnecessary tumult and suffering. This may be done, it ought
to be done, because it is siifer and more efficient.. I have already
alluded to the manner in which the application of even a shallow
bath, instead of a rubbing sheet, may increase the chronic visce-
ral congestion ; imagine this blunder continued through weeks oi
mcmths, and with still more powerful processes than either of
these ! No : the object of the positive means of the water cure is '
to aid, not to force, the visceral energies ; to withdraw causes of
disease from them, to produce a diversion in their favor, and to
assist them, in the exact proportion in which they require U, when
that diversion is made.

To return. The aim of the natural efibrt thus excited in to
rid the noble parts of the body of excess of blood. The relaxed
and enfeebled blood-vessels of those parts obtain, from the re-
newed activity and power of their ganglionic nerves, the power
of contracting, of driving their oppressive weight from them.
By this the equilibrium of the drculaiion comes to be gradually
established, and with it the eqmlibrium of organic sensation.
Hence the fact experienced by so many water patients, << that
they never bad warm feet until tbey used cold water;" that
water gave energy to the visceral blood-vessels to throw blood
towards the feet, and it r^gnained there, because it was sent
thither by the power of the frame ; whereas the hot water for-
merly employed added its own artificial heat to, and drew blood
towards the feet, that heat and blood receding when the water
was withdrawn, and leaving the feet colder than ever. Aou
this applies to the circulation on the entire surface. of the body.
Still repeating the tonic and soothing applications to the skin, the
inner organs gain day by day, by sure and lasting progress, the
power of sending their excess towards the skin, whither it is in-
vited by the processes going on there. This may proceed until
sweats, exudations of different kinds, eruptions, boils, &c., an-
nounce that excessive circulation of blood goes on in the outer,
instead of, as it previously had dcme, in the inner skin or mucous
membranes; so completely are things reveraed, and the vital
Murts savad by the water treatment«>
15

914 ACnOH OF TBE WATEB TRSATUENT

Bot the blood.yesaels of the ioternal parts are relieved by
another action of their own. So soon as, by the contracting
action just spqj^en of, they are rid of a certain quantity of bloody
they regain their secretory power, which had 'previously been
impeded or suppressed by the loss of ganglionic nervous energy,
and by the morbid accumulation of blood in them. Now that
they have regained some of their energy, and diminished some of
their contents, they further diminish the latter by pouring out
their usual fluids, which are generally at first diseased in kind,
but gradually improve. In this manner it is that the dry tongue
becomes moist, together with the mucous membrane of the
stomach, which begins by pouring out acid and mawkish secre-
tion, but ends by secreting healthy mucus ; and the liver, toa,
from being torpid, yields diseased and then sound bile. This
secretory action sometimes occurs to such an extent as to excite
the stomach to vomiting, and, after several days of preliminary
qualms, which announce the state of organic effort, quantities of
mucus and bile are rejected, forming in certain complaints a
hiUous crisis. This renewal of functional activity both releases
the blood from some of its parts, and decreases the quantity of it
in the organs in question, and quickens its passags through ves
■els in which it had hitherto stagnated.

The retention of excessive blood in the upper organs of diges-
tion, and in the brain and spinal cord, has been shown to be the
efficient cause of constipation. As the irritation of the digestive
organs induces that of the brain and spinal cord, so, when the
former lessens, the latter diminishes also. Thus two morbid
causes being removed, the lower bowel begins to act, and by it
the blood is relieved of certain parts which had hitherto been re*
tained in its current from the inactivity of the colon. In this
manner fUrther relief is brought to the mass of blood in general,
and the upper digestive organs in particular. Sometimes the
surface of the colon, which, like the skin, had been long inactive
in ccmsequence of irritation elsewhere, is not only released and
rendered active by the cessation of such irritations, but, like the
skin in that respect also, is made the part on which the exoessiye
blood of the irritated organs is thrown for relief. In such instan*
oes purging takes place, and is occasionally critical of the disor-
der of the stomach, liver, &c.

'IX. The removal of irritati^m and congestion from the primary
ive organs necessarily allows of better digestion of food, aiMl

Uf CHBONIC DISEASB. S15

Aerelbre leads to the formation of better blood. This is an fan-
portant consideration in chronic disease, where the mal-distribu-
tion of that fluid has time to deteriorate the whole mass of it by a
long course of bad digestion. From such poor and morbid blood,
morbid solids are deposited ; and as these regulate the distribu-
tion of that, the maldistribution inveterates. It is clearly neces-
sary to form new and better blood, and to remove the old and
morbid mass. We have seen by what means of the water cure
the new blood is formed : we shall presently see how the old
blood is removed.

When blood is deficient in the body, the same rationale of its
formation applies. There is still the same congestion and bad
disthbuticm to remedy, and, that done, the digestive organs recom-
mence their blood-making functions. It is to be remarked, that defi-
cient blood implies a much more advanced and complicated charac-
ter of chronic disorder than mere mal-distribution in a frame well
supplied with blood. Hence the water cure requires to be more
carefully applied, and for a longer period, in the case of blood-
lessness, than of simple visceral congestion ; you have not only
to distribute J but to make the blood as well. One striking and ex-
cellent feature of the water cure is, that the same appliances which
indirectly aid in the formation of improved blood, directly aid in its
improved distribution ; these appliances being the negative and
positive means hitherto under consideration.

X. Chronic internal congestion tends to bad digestion and
Dlood-making : no disease can go on without, sooner or later, ac-
cording to its degree of intensity,* vitiating the circulating fluid.
And this is aided very much by the absorption of medicinal sub-
stances in the ordinary mode of practice with them. On this
point there can be no doubt : again and again I have detected the
odor and color of colocynth, of aloes, of gamboge ; in one instance
of camphor even, in the cutaneous exudation upon compresses.
Whether their presence in the circulating blood has a deleterious
effect on nutrition may be a question, since proof, when there is
digestive disease to account for the bad nutrition we see, is hard
to get at; all physiological probability, however, favors the
belief of its mischievous operation. Be this as it may, diseased
blood attends old-standing internal disorder ; and as the means of
the water cure already reviewed tend to remove that disorder, we
have next to ask what means are applicable for changing the
I of unfit blood which follows it I

916 ACTION OF THB WATEB TBBATMENT

They are to be found in the toater drmking, the exposure fti
pm'e air, and the exe^cisCy which form so important a part of this
hygienic treatment.

In treating of water drinking as a means of changing the mass
of circulating blood, it is impossible to avoid reference to the
chemical doctrines of Libbig on this subject. But I shall be
brief in exposing the mode in which they apply to this process.
Three years ago I wrote a work,* which contains the rationale of
such application, and the chief portions of which. I republish as
the Appendix to this volume, where it may be read at greater
length. At present it is only necessary to state, that Libbig's
experiments go to show, that all the elements of the blood are in
the food we digest ; that all the elements of the solids and fluids
of the body are in the blood ; that the antagonist processes of
deposit or solidification of the blood, and of breaking down or re*
liquefaction of the solids, are incessantly going on ; that waste
of the whole material of the body is also incessantly going on ;
that these acts of change and waste (waste being, according to
him, an actual process of combustion), constitute the leading
• phenomena of the living body. Further, he shows that the
supply of material for this waste is in the digested aliment con-
verted into blood ; and that the rapidity of waste, as well as of
the changes alluded to, is varied by different circumstances.
And the circumstances which quicken the waste and changes
most strikingly, are a copious supply of water to the blood, exposure
to cold air, and exertion of the nervous power in bodily exercise.

According to this view, so l6ng as the digested food supplies
the materials for waste, and a proportionate amount of water, air
and exercise are taken, the stationary condition of healthy or of
equal supply and waste, obtains. When the food taken and
digested exceeds the waste, in consequence of avoiding water, air,
and exercise, diseases of repletion, inflammatory diseases, take
place. When, on the contrary, excessive dilution, long exposure
to cold, and exertion jof body, hasten the waste, supply in the shape
of fixxl not being in proportion diseases of depletion and emaciation
take place. Persons, says Libbig, die of chronic diseases because
their material is wasted without proportionate supply. In other

• « The Dangers of the Water Cure examined," &c. 8vo., 1843. Sim-
tiltaneously with this work appeared Dr. E. JoHwsoif's «« Hydropathy,'*
wherein the same application of Liebtg's doctrines is made, but more
Wly, and, ccatainly, more cleverly than in my production.

I7f CHRONIC DI9SA8£. SIT

words, chronic disease kills from failure of the central and
primary nutritive power situated in the digestive organs, a&I
have stated in the First- Part of this work.

Granting these chemical doctrines of Liebio to be sound (and
only a few minor objections have been urged against them), we
have at once the key to the mode in which water drinking,
abundant air, and exercise, produce a change in the circulating
blood. They produce it by expediting the chemical changes and
waste. And whilst the positive and negative means which have
been above dilated on are relieving the central organs of nutrition
from oppression, and thus causing a better digestion and supply
ing better blood, the water drinking, air, and exercise, are quick-
ening the operations by which the old diseased blood is to be
wasted and got rid of.

I insist upon the division of these two effects of the water treat-
ment. The effect of better distribution of blood is brought about
by the processes mentioned in the first eight divisions of this
chapter, by the external applications of the water cure. The
effect of change of the mass of blood is wrought by the internal
application of water, the exposure to air, and the exertion of the
frame. These are distinct acts, although they go on simultane-
ously in a body, whose chronic disease requires that both should
be excited.

And here, in my belief, founded on large experience, is a
question of great importance in the practice of the water cure :—
Do all chronic diseases require that both a better distribution and a
total change of the blood should be eflected ? The same experience
compels me to answer, <*' unquestionably not : there are diseases
in which the only proximate cause is a mal-distribution, and in
which the mass of the blood is not diseased." Let us examine
int9 this a little ; it involves the question, whether large doses of
water and great exercise in the air are essential to the cure of all
chronic diseases ? Physiological reason aids experience in proving
the negative.

• When it is said that such and such chemical changes are
effected by water drinking, let it be always remembered, that we
know of no increase in the functions of a living body without in-
crease in the functional activity of its nervous system* All agents
whatever produce their first impression on that system ; all. the
chemical changes implied in secretion, nutrition, &c., are pre-
<ieded by a change in the vitality of that system. The water

-9)8 ACTION OF THE WATER TREATMENT

• cure; has been treated of as a mere affair of ehemical transpoai*
Uons, but that is a very unphilosophical view to take of it, those
transpositions being secondary to, and the result of certain con-
ditions of the nerves. Now, the presence of a large additional
quantity of water in the circulating mass proves a stimulus to the
organic nerves which so plentifully supply the minute blood-
vessels. In these blood-vessels the chemical changes in question
take place, and they are stimulated to augmented activity of
ohange by the water. This activity continually increases, so
long as large doses of water are continued, and with it the activity
of the nervous system, which at length becomes involved in its
whole extent, the animal as well as the ganglionic system, the
brain as well as the viscera. This is amply exemplified in the
increased rapidity of pulse, of appetite, of secretion and exertion,
of . sensitiveness, amounting to nervousness, sleeplessness, and
irascibility, which attend large water drinking. And it is quite
true, that the heart may be stimulated to excessive and rnorbid
action, and the brain to maniacal and apoplectic fulness, by the
excessive taking of water. The enemies of the water cure say
that it always produces these results ; but it is only the abuse of
Wiier drinking that renders the body liable to them ; neither, so
far as I read and hear the accusation, do the accusers appear to
imderstand how even its abuse is to cause the mischiefs they pre-
dict. The explanation is that which I have given ; and an illus-

' tration of the danger of large and sudden dilution will be found
in Case XXI.

. Well ; suppose a patient with general fulness of body and
apoplectic tendency in the head were to be told to << drink as
much as he pleases — ^the more the* better " (a not infrequent in-
struction with routine water doctors), the chances are very much
in - favor of the tendency ending in a seizure. Or suppose the
other extreme of emaciation and bloodlessness, that state in which
all the blood of the body is centred in the citadels of life, the
viscera and brain, the certain result of large water drinking
there would be to increase the unequal congestion of those parts,
probably to induce paralytic pressure in the head. In both cases,
the nervous system would be greatly increased in activity ; in
the former, the already too full brain would be further and ra-
pidly filled, until sudden pressure occurred ; in the latter, the
sanie pressure, only more gradual, would occur, the absolute
4|aaatity of blood in the body being smaller. Or suppose a <

nr CHBONIC DX&BASB. 8l0

ill which the pulse is rapid, the stomach highly senshite, the
brain excitable, — a case of ordinary nervousness, in shorty — ^the
consequence of large water drinking there would be to increase
the nervousness tenfold. And several analogous cases might be
instanced, where the malady being one of acdve irrUation and
tnal-distribtUion alone, the vigorous application of this part of the
water cure is sure to prove more harmful than useful. Where
the malady is one of obstruction and diseased blood alone, or con-
joined with mal-distribution, water drinking may usually be
carried to a considerable extent with benefit ; and it commonly
happens that cases of obstruction are those of diseased blood also,
the fiu-Mier causing the retention of chemical elements which
vitiate the blood. I shall return to this subject in the succeeding
chapter.

Abundant exposure to air and great exercise aid in changing
the quality of the blood, by expediting the waste alluded to ; for
this waste is effected by the action of oxygen upon the com-
bustible materials, the carbon and hydrogen of the body. This
takes place still more rapidly when exercise of the limbs, and
therefore of the brain and spinal cord which tnll the movement
of them, is added to exposure to air ; and the colder the air the
- more rapid the waste. A man skating on a frosty day consumes
more oxygen, and therefore is himself more consumed, than if
he were seated in a temperate room, or even in a frosty air.
And a person driving in a carriage consumes less than one walk-
ing, besides having much less strain upon his nervous system.
Thus the question of mal-distribution or disordered blood should
be raised, when the quantity of air and exercise is to be de-
termined. Neither in this nor in water drinking is an unchanged
order for all cases admissible.

XI. The ultimate action, therefore, of the appliances of the
water cure in chronic disease is, to induce a better distribution of
blood, by withdrawing ike excess of it from the nutritive viscera ; to
cause the formatixm of sound, nutritious blood : and to rid the body
of the diseased blood which circulated in it.

These phenomena take place in the order in which they are
mentioned. First of all, the viscera are liberated from the blood
which oppresses them. As a consequence of this, these viscera
proceed to make better blood, the means which aid its healUiy
distribution still going on. And lastly, as the viscera gain mom
mganic power by being liberated from their (yp ro oa i o n i and the

8S0 ACTION OF THE WATER TREXTMEMT

whole body gains more organic power by being nourished with
better blood » waste is more quickly and safely carried on, so as
to insure the expulsion of diseased fluids from the body. But
though such are the physiological processes, it must not be sup-
posed that each one waits until the preceding one is /ttZZy ac-
complished. So soon as internal congestion begins to diminish,
better blood-making and nutrition begin also^ and, with these,
the elimination of diseased blood. The triple process depends
for its vigor upon the restoration of the organic, ganglionic, vis-
ceral power, — ^the power to which, as a curative, and the only
truly curative agent, — ^the generic name of Nature is applied.
The water cure, aiding in the liberation of this power of Nature
from oppression, subsequently aids it in the efforts which it makes
to restore utterly and permanently the equilibrium and the in-
tegrity of the nutritive liquid, the blood. With this equilibrium
and integrity comes health— ^erwiawcni health, if morbid causes
be avoided.

In the course of the efforts which Nature makes, with the co-
operation of the water cure, it sometimes happens that the new
distribution of blood which they bring about is so energetically
effected as to cause morbid congestions of blood in other organs
than the diseased viscera. In this manner congestion of the
lower bowel takes place, and is exhibited in diarrh<Ba ; general
congestion of the skin takes place, and is exhibited in sweats of
nervous kinds ; or partial but more intense, congestions of the
skin take place, and are exhibited in eruptions of various kinds,
and in hails of various degrees. To these exhibitions of transfer-
red irritation and circulation the name of crisis is given. Be-
cause, in the matters eliminated from the bowels in purging, and
from the skin sweats, moist eruptions, and suppurating boils, there
is more or less of a morbid character, it has been said that it is by
them that the diseased condition of the blood is rectified ; that,
in fact, they carry off the diseased matter of it. But this will not
stand : the disorder of the blood consists in the absence of
elements which should render it fit properly to nourish the tissues,
and not in the presence of the mucus, sweat, or pus, as such,
which are thrown off respectively by the bowels and skin ; that
conjecture is one of the most coarse and gratuitous of the ex-
ploded humoral pathology, but has been renewed by several
unlettered and illegitimate practitioners of the water cure. It is
true thftt the cutaneous secretions have on some' occasions fihown

Uf CHRONIC DISEASE. 82]

the presence of medicinal substances in the circulating blood ;
but it is not probable that the mere presence of medicines oonsti-
tutes the disease of the blood ; and critical action much more
frequently happens without than with their elimination. Indeed,
crises of all kinds occur without evidence of any sort of disorder
save a maldistribution of blood ; just as frequently, in fact, as
when there is the addition of disordered blood.

Critical action, then, as a result of the water treatment, signi-
fies that the viscera have been enabled to throw their irritation
and blood upon some other organs, the lower bowels or skin ; and
that this excess of blood and this irritative action attempt relief
by throwing out large fsecal secretion, or unusual cutaneous
secretion. That is all that can be said of a crisis ; it is an out-
ward and visible sign of the exercise of a power on the part of
the inward organs, to save themselves by a transfer of mischief
to parts less essential to life. To -push this by continued treat-
ment under the idea of extracting more " bad stuff" is sad stuff,
and may be harmful ; we should be content with the evidence
the crisis gives of efficient rousing of the self-restorative power,
and diminish, or even altogether cease the treatment, for a period
at least.

The occurrence of a crisis, however, is neither frequent, nor is
it necessary in many cases. The gradual progression of improved
distribution of blood, of improved formation of blood, and of waste
of diseased blood, effected by a judicious application of the water
cure and a regulation of diet, tends towards a recovery which is
quite as effectual and permanent as that of which a crisis is a sig-
nal. Of this I have satisfied myself in many instances : and any
one who observes the treatment and employs thought upon it, will
see how unnecessary were all the wonderful crises which were,
at an early date of the water cure in this country, imported from
the continent to astonish the English public. Such crises may
have taken place, but I am certain very often very unnecessarily.
Violent treatment, no doubt, will excite them much more frequent-
ly than mild treatment ; but I maintain that this last suffices for
all purposes of cure, and causes much less inconvenience and
mischief. In the one case you cautiously and gradually work
upon the nutritive nervous system, keeping it up to the point of
slow, continued effort of self-restoration ; in the other, you force
it suddenly to a violent effort, and in doing so produce vehement
levulsive and tumi^ltuous Action in the great nervous centres. I
IS*

t82 ACTION OF THE WATBS TB£JlTMBlfT

do not believe there is an atom of danger in the latte^, in the can
of an educated physician ; but it has not, so far as my experiei\Qe
goes, advantages enough over the slower [4an to render it a grieat
aim.

The facility of exciting critical action varies very much in in-
dividuals ; nor is it easy to say beforehand who shall fall under
it the most readily. As a general statement, it may be said that
persons of moderate stoutness of body, with a circulation rather
slow than otherwise, incline to the critical action of the skin which
is exhibited in boils. These are also more frequent when the
patient has been a great physic taker, especially a taker of vege-
table purgatives ; or if he has been an excessive drinker of alco-
holic liquors. On the other hand, when the patient is lean, toiry,
of vivid nervous system and circulation, internal crises of purging
or vomiting, or external crises of diffused eruption or of sweat are
more generally met with ; or when the malady is one of md-
distribution only, and especially of the class called nervous ; in
these an itchy eruption, or a feverish attack ending in sweat, are
the usual critical signs. But all these points are of comparatively
small consequence ; the patient may very commonly be cured
without any crisis, properly so called ; and the practitioner who
insists upon it may gratify the marvellousness, but will very dis-
agreeably disturb the economy of his patient by his pedantry or
his quackery. But although the phenomena of a crisis, as above
mentioned, are not necessary in very many cases, a change in
the nervous and circulating functions must be wrought by the
treatment, — a change equivalent in degree to that of which sweats,
eruptions, dec, are evidences, but procured and eidiibited in a
more quiet and less vehement manner.

XII. The preceding numerical heads, of the subject of the
action of the water cure in chronic disease, include the rationale
of that action, so far as the vital agency of the body is concerned.
I have only briefly alluded to the chemical changes effected in the
body by the drinking of water ; they will be found more in detail
in the Appendix. But it should always be remembered that,
however curious and potent a part these changes may play in the
action of the water cure, they are secondary to the changes of the
viUd condition ; nor can they be commenced or continued without
that condition being previously altered. A physician may be
well acquainted with the chemical phenomena announced by
L1BBIG9 and with their application to the explaQatioaof tiia t»i

ni CHRONIC DI8XA3S. 93S

salts of the water treatment ; but unless he is able well to measure
the vital organic capabilities of his patient, his blood-making and
nervous power, the chemical applications will rather lead him
astray than assist him in the treatment of disease ; he will only
be able to see a series of chemical changes, and will take what
liiEBiG says is the shortest way to effect them, without consider-
ing whether the living hody^ not the chemical hharaiory, is able to
bear the means for rapidly producing the changes in question.
Remarks of this kind are necessary, because the doctrines of
LiEBiG have been insisted and expatiated upon by writers, until
readers behold nothing in the water cure but a series of chemical
changes which they can themselves induce by their own devices.
I have known this chemical crotchet lead a patient to treat him.
self with enormous doses of water, for the purpose of expediting
the processes of the laboratory, which he conceived his body to
be, and thereby put his brain into the most imminent peril, apo-
plexy having as nearly as possible occurred from the violent
stimulation of the nervous system thus excited.

In order to make more clear the views which observation has
led me to adopt concerning the mode of action of the water cure,
and which I have advanced in this chapter, I will recapitulate the
subject of each of the foregoing numerical heads, which are all
connected by a chain of experience and reasoning.

I. The power of Nature is advanced as the only truly curative
power.

II. The water cure is shown to be that form of medical art
which is best adapted to aid Nature in her curative efforts, and
the least liable to interfere with and thwart them.

III. The first step towards aiding that power of Nature is to
withdraw from the organs all mental and bodily irritations. This
constitutes the negative means of the water cure.

IV. We here inquire the seat and centre of that power of Na-
ture which is liberated from oppression, and excited to action by
the withdrawal of mental and bodily irritants. And we find it
to be in the ganglionic system of nerves dispersed throughout the
body, but having its central portion in the viscera, which are thus
the sympathizing centre for all diseased actions in the body.

V. Hence, it becomes essential, in applying the water cure in
chronic disease, to inquire minutely into the organic ccmdition of
the viscera. And we find that to be a condition of ezcemve

324 ACTION OF THR WATER TBEATIIEXT

blood, in the shape of chronic irritation, inflammation, congestiof^
and obstruction.

VI. It therefore is of consequence to avoid means which tend
further to increase the quantity of blood in the viscera, and to
employ those which tend to bring it from the viscera towards those
organs which, in consequence of the excess of blood in the viscera,
have been deprived of a sufficiency of it. This is especially the
fact as regards the skin, the vitality of which is the most seriously
compromised by the internal congestion. To the skin, therefore,
the second series of means are applied : these are the positive
means of the water cure.

VII. Treats of the organic power of the skin, its conaection, by
ganglionic influence, with other parts, and how it acts directly
upon the viscera, and indirectly on them, through the brain.

VIII. The viscera, liberated from oppression by the negative
means, and aided by theposUive means of the water cure, acquire
sufficient power to rid themselves of their excess of blood by send-
ing it towards the skin, and by outpouring of secretions from the
stomach, liver, lower bowels, &c.

IX. The removal of internal irritation, congestion, &;c., by
these means, enables the nutritive viscera to form better blood and
better solids ; and, by means of these solids, to effect and main-
tain a better distribution of the blood of the body.

X. Whilst the blood is thus being better distributed, and formed
of a better kind, the elimination of the old morbid blood is being
effected by another means of the water cure, namely, water drink-
ing. This it does by expediting those chemical changes of the
body which are known to take place under the influence of the
vital, organic power of the body, and which in a certain time
change the whole of its fluids and solids. Air and exercise, other
)»ositive means of the water cure, assist in these chemical changes.
These means, therefore, should be applied according as the dis-
ease to be treated implies mal-distribution of blood alone, or that
with the addition of diseased blood. It is in this latter case that
they are more particularly and largely demanded.

XI. Making its first impressions, therefore, on the nutritive or
ganglionic system of nerves, the water treatment in its ultimate
action has a triple result, — ^to cause a better distribution of blood,
ti induce the formation of better blood, and to purify the blood.
These stand in cause and effect as they are mentioned ; the better
distribution leading to better blood-making, and fhb gifii^ tbo

IN CHBOmC DISBASX. 825

body power to suaUin the increased waste which is requishe to
purify the whole mass of blood. A visible evidence of these re-
snlts is sometimes exhibited in the form of a crisis ; but this is
not essential ; and the treatment which tends to cause it is, for
the most part, better postponed for <Mie less vehement in character
although equally efficacious in result.

Regulated by these views of the action of the water cure, I
have found it a safe and successful mode of treatment in a num.
her of chronic disorders, the major part of which are mentioned
in this volume. I fear that my views, and the practice founded
on them, will be considered heterodox by those who are of opinion
that water cures everything, and can possibly do no harm ; who
therefore prescribe pretty nearly the same routine of violent pro-
cesses and huge water drinking to every patient, whatever his
malady or his organic condition ; who, in short, are " water doc-
tors'* and nothing more.* But this is not to be controlled ; facts
have stared me in the face for four \ oars, which demonstrate the
possibility of avoiding a great number of 'disagreeables by a sci-
entific adaptation of the appliances of the water cure to the
organic capabilities of each patient, and of arriving at a success-
ful termination quite as surely as if the patient had been all day
in water, and water all day in him. Besides, it is folly to sup-
pose that improvement is never to be made in this mode of treat-
ing disease ; that as Priessnitz originated it, so it is to remain
through all time. Priessnitz is far too clear in mental vision,
and original in thought, himself to stick fast in one routine ; for
in the course of his long experience he has considerably varied
his practice ; and it is satisfactory to know that now, afler more
than twenty years' experience, his treatment has lost almost all
the violence which characterized it in former years, and that he
too finds he can do as much with much milder means. I doubt
not that, in due time, he will discover that such means are still
more efficient when diet is regulated, and that the abominations
of his table, to which all who have seen it bear witness, will be
reformed. With keenness to observe he has the tact to adapt his
practice to the facts which observation imposes on him. Not so

* I have heard a saying, *< that water cures the mischief that water doeSt
—go on drinking," — ^attributed to PjiisssNrrz, but am unwilling to bsliers
that so acuta a man could have uttered such nonaenM

SM ACTION OF THB WATXE TKEATMSNT IN CHEONIC DISBASB«

•

the small persons who run over to Grftefenberg fi>r a few weeks,
and return to practise the same processes on delicate English
women and Englishmen with sensitive and care-worn brains^ which
they had there seen practised on phlegmatic Germans and bard-
headed Poles ; and who, though they fancy themselves Pbikssnitz,
and come back " doctors,'' are in reality as much one as the
other. From such I am compelled to differ in my ideas of the
best manner of applying the water cure ; and I am also com.
pelled to hold, that its employment requires as much nicety and
discrimination as any other plan of treatment, and may not safely
be trusted to a routine. Knowledge of sound physiology and
pathology are never more required than in the practice of the
water cure ; and in no system of treatment will the great truths
of those sciences find more ample and beautiful confirmation.

SBXAIU OF THS WATBE CIFBB. MT

CHAPTER n.

DETAILS OF THE WATER CURE AND EXPLANATION OF THEIR

ACTION

Division of the processes — ^Hot and warm fomentations— Packing in damp
towels and sheets— Sitz baths — Abdominal and local compresses — Drip-
ping or rubbing sheets — Shallow bath — The douche— The sweating
process — ^Foot and band baths — Other ablutions and frictions — ^Water
drinking— Diet, air, and exercise.

[The portions of this chapter which are included in these
marks, *' " are reprints of a contribution from my pen to Dr.
Wilson's pamphlet, " The Practice of the Water Cure," in
which they were published].

Thb processes of the water treatment have been multiplied by
charlatanism as well as by ingenuity and judgment. Water has
been squirted in all imaginable ways, and has been made to flow
from all directions in all kinds of streams, upon the human body ;
and complexity has been largely employed to lure such persons
as simplicity might fail to attract. This is all very well for those
who see nothing in the water cure but an " establishment in full
operation," and rely more upon the possession of " every variety
bath," than of the requisite knowledge to apply water. Patients
may be for a time amused, or their confidence and hope re-excited
by such contrivances as " ascending douche baths," " wave baths,"
" ascending sitz baths," &c., but, although I have seen very many
at Malvern who have gone through all these ingenuities elsewhere^
they had never had their diseases explained to them, and were
pretty nearly as far from a cure as ever. And s^ it will ever be
when the lucrativeness of the water cure is more considered than
its philosophy, and so long as professional men, by holding back
from investigation of the subject, allow so excellent a plan of
treatment to be usurped by non-professional adventurers and soi»>
Usant " doctors."
Patting these QOiitrivaDiC«« wde, I shall confine myielf, in tbii

199 ROT AND WAUI FOMBNTA1IOH8.

chapter, to the explanation of those processes which are essentia]
to the water treatment of chronic disease, and the varied modifica-
tions in the applicatioD of which suffice to meet all cases that are
proper to he submitted to that treatment. Any precise division
of them it may be difficult to make ; but as in chronic disease we
have recognized one condition, which is that of active irriiadon of
the viscera, and requires to be subdued, lowered, and another con-
dition, which is that of depression and obstruction, and requires to
be roused, stimulated, and to have tone imparted : so these pro-
cesses of the water cure may be divided into such as are adapted
for subduing irritative and inflammatory action and such as have
the power of giving tone to, of stimulating, and rousing organs
whose function is at a low ebb, or obstructed and torpid. Modi-
fications, however, of one or two processes may be so made as to
' make them either sedative or tonic, as the sitz bath, a long dura-
tion of which is lowering and sedative, whilst a short duration is
tonic and stimulating. But these instances are not numerous
enough to warrant sub.divisions : and I therefore proceed to treat,
in the first place, of those applications whose general effect is to
subdue irritation.

§ 1. Hot and Warm Fomentations.

This invaluable mode of applying water was first put forward
in this country by myself in the Lectures by Broussais, which I
published in the year 1845. Among the French it has long been
esteemed and practised. I know no more powerful agent for sub-
duing a certain phase of visceral irritation, and I employ it very
frequently. Although a simple remedy, it is very little known or
practised in this country, and I shall therefore state the mode of
its application, which I shall not do with the other water cure
appliances, they having been described again and again, until the
public who read works on the water treatment must be wearied
of it. No English work on the water cure speaks of fomentations
such as those now under consideration.

A piece of Qannel thrice folded is placed into a dry basin, and
very hot or warm water is poured on it sufficiently to soak it.
The flannel is then put into the corner of a towel, which is twisted
ivmnd it and wrung until the flannel is only damp. It is taken
out of the towel and immediately placed over the part to be fo-
mented, and upon it is placed a double fold^of thick flannel, dry^
or part of a light blanket. The patient then, if it t« the abdo.

HOT AND WAKM FOMENTATIOBni. 999

men which is fomented, draws the ordinary bed clothes over him,
and remains quiet for five or eight minutes, when another flannel
freshly wrung out is applied, the former one being withdrawn.
And this goes on for the whole time prescribed for the fomentation.
The most ordinary place for applying this process is on the
belly, and especially the portion of it between the bottom of the
breast bone and the navel, and across far back on both sides : this
may be called general fomentation, its effect being on the pheno-
mena of the whole body, in contradistinction to loccU fomentations
of joints, &c. In this manner you include — ^the colon as it
crosses the upper part of the abdomen, the stomach in all its length,
the Uver to the right, the spleen to the lefl, and a portion of the
small guts situated above the navel : and, if the fomentation ex-
tend all over the abdomen, the remainder of the small guts, the
head of the colon (where the fseces are formed), the bladder, and
the toomh. And last though most important of all, you include
the large and thick networks of ganglionic nerves, and the gan-
glions themselves, which pervade and regulate the functions of
these great organs of primary nutrition and excretion. This is
no small consideration, and a priori 'the application of a process
at once soothing and counteracting to such organs recommends
itself to a physiological physician. But the actual result passes,
in many cases, all anticipation. Oflen and again I have seen it
procure sleep to adults, and to children especially, when opiates
only fevered and irritated. I have seen it, applied at night, pro-
cure relaxation of the kidneys and bowels by the morning, when
all diuretics and purgatives bad failed. I have seen it arrest the
most violent bilious and nervous headaches. I have seen it stay
fits of asthma, of tic douloureux of the face, of toothache, of
sciatica, of spasm of the bladder, of universal convulsion in in-
fants both from teething and indigestion. I have se^n it stop the
most violent and long continued vomiting, and relieve, even dur-
ing application, extreme acidity and flatulence of the stomach.-
These things I have seen, not once, but scores of times, and in
any of them I should use it with confidence of quick relief, more
speedy in some than other cases. The explanation of such re-
suits from a remedy applied over the seat of the great centre of
the nutritive nerves of the body, will not be difficult to those who .
liave read the exposition of acute and chronic disease given in
the First Part of this work.
'The 'temperature of fementations over the bell; ift of great

StO BOT AND WARM FOSSBlfTATIOMS.

importanoe. Where the symptoma indicate a purely:;
iory state of any of the viscera — when, hr instance, mucous indi-
gestion prevails — the temperature should be high, nearly at the
boiling point : the object then being to counterirritate, to draw
blood to the surface, in doing which the nerves of the skin are
vehemently stimulated. But when the visceral irritation is of a
nervous character, and therefore capricious in its phenomena, it
behoves to apply the fomentations only warm, so as not to exdte
but sooike the nerves of the skin : for if you excite them, the ex-
citation will be propagated to the brain, and produce malaise
there, and sometimes will even be a means of increasing the vis-
ceral irritation it was intended to subdue. I have often seen fo-
mentations to the abdomen, improperly tempered, induce severe
Jieadache, throbbing and restlessness, the irritation produced on
the skin being promulgated to the viscera and the brain^ In
more vehement inflammatory action within, such a reflection, as
it were, back on the nervous centres from the skin, is not likely
to occur, the irritation in these being already very great and of a
decided character. These are the leading indications as to tem«
perature, and the gradations between the extremes of pure in-
flammatory and nervous disorder must be left to the discrimina-
tion of the practitioner.

Hot fomentations should never be applied to the abdomen ex-
cept when the patient is in the recumbent posture, and can take
rest after them. Being a lowering remedy, especially in dimi-
nishing the excitability of the brain, exertion of the limbs should,
upon no account, be allowed immediately subsequently on their
application. Indeed, it is better that sleep should be taken : and
hence, bedtime is the best time for them. They should never be
applied within at least two hours and a half after a meal» with
the digestion of which they would otherwise interfere. The du-
ration of this process variies from twenty to sixty minutes every
day, or every second day, according to the indications a^rded l^
the degree and kind of internal disorder.

Fomentations, although directly lowering, are, indirectly, a
strengthening process. The inflamed stomach of a patient acts,
by sympathy, as a spur to the function of the brain, which there-
by exhibits a degree of impulsive energy that passes for power .
the patient can walk and talk quickly, has incessant desires to
move, &c. : but all this is fictitious strength, just as the enei^
Imparted by alcoholic liquids or tonic medicines is fictitious. Fo

HOT AHD WARM FOUSlfTATlOKS. Ml

mentatioiis, by redueing tlie inflammatioo of the stoniach, witii«
d]raw the spur from the brain : and the patient, feeling in conse-
quenoe much loss of his locomotive propensity, says they are
weakening him. But they are plainly only reducing his brain
to its actual and genuine level of strength by taking from it the
moibid stimulant which gave it fictitious power. And, mean-
time, the digestive viscera, being strengthened by the reduction
of their inflammation, will, as they improve, afford such natural
stimulus to the brain as will give it a sustained energy. I dwell
upon this, as patients often make complaint, in the first parts of
the water treatment, that they are weaker : these fomentations,
and the wet-sheet packing generally forming those parts ; where-
as they are only weaker for a time in the animal nervous system,
but are becoming permanently stronger in their nutritive nervous,
system ; and that is the great consideration : strong viscera are
always accompanied by strong brain and spinal cord. It is, how.
ever, necessary to mark well the point at which to discontinue
the use of this remedy ; if they be continued one day beyond the
reduction of active irritation, they really weaken, and induce the
headache and other symptoms already mentioned, which attend
their employment at an excessive temperature. In this respect,
the pulse is the best indicator : when it has lost sharpness and its
ierky character, hot fomentations are superfluous, and their con-
tinuance would render Jt small, weak, and exceedingly irritable.
Hot and warm fomentations form an excellent commencement
to the treatment of those cases, where with active irritation exist-
ing in the viscera, there is such a want of vitality and blood in
the entire body as to render the immediate employment of the
cold remedies adapted for the reduction of that irritation impossi-
l^e or hazardous. I have constantly found that in old persons,
delicate females, bloodless and greatly debilitated patients, espe-
cially in those aflected with bronchial and, asthmatic disorder of
the lungs, it became possible to apply the colder remedies of the
water cure by first using these fomentations for a period. A cer-
tain amount of the mal-distribution of blood within was thereby
overcome, and a better circulation to the exterior thereby attain-
ed, which enabled the skin to re- act upon the cold wet sheet,
when it would otherwise not have done so, without much sense
oi naisery, at least. Extreme congestion and extreme general
weakness may be thus coaxed, as it were, in commencing the at«
ten^at self^restaration, whilst other means- would have over-

dd*i PACKING IN DAMP

whelmed them. By their aid I have often been enaUed to begfa
the treatment of delicate persons in the middle of winter, who
must else have postponed it until summer heat assisted the skin.

When there is a good amount of feverish ness present, hot
fomentations, applied for half an hour immediately after a wet-
sheet packing and the rubbing sheet or shallow bath, are excellent
means for seconding the febrifuge qualities of the packing, and
the two together are almost sure to induce perspiration and
terminate the fever.

Local fomentations with hot and warm water are not often re-
quired in chronic disease. In the exasperations ofgotUp or rketi-
maUc inflammation of the joints which occur in the course of the
general water treatment, they may be used with advantage, at a
low temperature. At the same temperature they are applicable
in certain skin diseases, particularly in chronic erysipelas ' Ifi
bad paroxysms o^ neuralgia, they afford relief applied at a high
temperature, the general fomentation being at the same time
employed. ' '

When, in disorders of obstruction, the efforts induced by the
treatment have gone to the length of causing some degree of fever-
ishness and nervousness, the application of warm fomentations at
bedtime reduces these symptoms, and thus allows the main treat-
ment by the tonic and stimulating processes to be continued.

§ 2. Packing in Damp Towels and Sheets.

The same remark which has been made regarding the weaken^
ing and lowering effect of fomentations applies to this process ; it
is directly lowering, but indirectly strengthening ; it reduces
excess of blood in one organ in order to send sufficient to another,
which has too little. Still, it materially reduces the circulation ;
and where that is very feeble, from deficiency of blood in the
whole body, it requires care in application. Hence I have found
it necessary to introduce (for it is not spoken of in works on the
water cure) the use of towel as well as sheet packing. In very
delicate and bloodless patients, I generally begin packing with a
single towel placed down the front of the trunk : and they will
be able to warm this, and not have the circulation so lowered as
when the whole body is enveloped in a damp sheet. By degrees,
as the blood begins to circulate better, I put a tdwel on the back
as well as the front of the ti'unk, and so gradually and safc^ get

TOWSLS AND 8BSST8, 381

Ob to the employiiieiii of the sheet over the wh<de body. Anothef
advantage of this partial packing at finit is, that the arms are
free, and this is no slight consideration to nervous and delicate
persons, to whom the constrained and helpless position of the
entire sheet packing is sometimes very disagreeable, and might,
by acting on the nerves, be harmful. By the use of fomentations
and the towel packing, I have been enabled to undertake and
successfully raise up patients whom, without them, I must have
altogether declined to treat.

The novelty of such a process as wet-sheet packing past, it
. becomes one of the most agreeable, because one of the most
soothing, of all the water remedies. By it the nerves proceeding
from the brain and spinal cord to the skin, and which are mor.
bidly sensitive in all chronic diseases, are relieved, for the
moment, from the irritation of the air, and placed in the mild
atmosphere of warm vapor which is made by the heat of the
body acting on the moisture of the sheet. Instead, therefore, of
irritations proceeding from the extremities of those nerves, spread
over the skin towards the brain, this last is quieted by the tem-
porary withdrawal of them ; so much so, that the patient ordina-
rily sleeps whilst packed, and will sleep then when be could not
sleep without it. On coming out of it, therefore, the nervous
energy of the skin having accumulated strength by the rest thus
given to the nerves, is in the best condition to react upon the bath
which follows. Add to which, that the quietude of the brain has
freed the viscera from irritations which it sends to them in the
ordinary progress of chronic disease, and thus they, too, are in
the best condition for reacting on the external application of cold.
The whole body has been rested, its organic powers have been
accumulated, and it can now respond to the stimulus to be applied
to its external surface. Accordingly, the shallow or sheet bath
is applied immediately, at an appropriate temperature, and the
result is a rush of blood to the skin ; a rush, be it remarked,
produced by the organic powers of the body itself, and not liable,
therefore, to be followed by a reflux. This process repeated day
af^er day, and sometimes twice daily, at length Jixes a quantity
of blood in the blood-vessels of the outer skin, and thereby
reduces the disproportionate quantity which was congested in the
inner skin or mucous membranes.

*^ Scientific medical practitioners are aware that there are two
waye of giving health and atreugth to a frame laboring ondei

m VAaasQ IN lump

di ieasc ^- v i2., by relieTing the irritatiao of Bome pctrtmilar ftit^
which disturbs and oppresses the other o^ns, uid by directly
giving tone to the really enfeebled body.

** The curative and strengthening operation of the wet sheet
mainly consists in the former of these ways. In all chnmic, a«
in all acute disorders, there is one organ, or series of organ%
whose irritation or inflaipmaticm proves oppressive to the oth^r
organs, and the cure is to be fi>und in the reduction of this inita*
tion. This fact goes far to explain the very extensive, almost
universal, employment of the wet sheet in disease. Its extraor.
dinary power in allaying irritation is one of the most curious fiiots
of the Water Cure, and of which it is really difficult to give a
full and satisfactory rationale. When properly modified to meet
the actual state of the patient, it may be said to be the most soothe
ing application that can be administered to the external sentient
surface. It may be compared in its calming effects to a pooltioe
placed all over the body ; but this is only stating a fact in other
words. It carries off feverish heat, and this heat is employed in
oonverting the moisture in the sheet into vapor ; so that the pa-
tient may be said to be in a steam bath of his own making. This
warm vapor settling on the skin, makes it soft and moist, and is
very ofien mistaken for perspiration ; but the wet sheet, used for
the purpose of reducing irritation, is not, as a general rule, allowed
to remain long enough to induce sweating, — which is a directly
opposite process, and intended for a different purpose from the
wet sheet. But whatever be the physiological principle upon
which the wet sheet acts, it will be found, during the treatment
of most diseases by the Water Cure, an indispensable remedy,
and one oa which the practitioner can safely rely.

" Being applicable where there is morbid irritation, it is an in-
valuable remedy in all internal and external inflammation, acute
and chronic. In acute disease it is frequently changed, the pa^
tient not being permitted to remain in it longer than suffices to
warm the sheet, which in fever, for instance, may be a quArter
of an hour, or even less. It is thus changed several times con.
seoutively, increasing the time as the heat is reduced, and the
shallow bath, cold or chilled, follows. In this process two evident
effects are produced, an immense quantity of keai is carried qf
from ike surface, the pulse becomes softy and fails in rapidiiy,

^ After this, when the patient has been some time in bed, tiie
haai en the soriSKse again acoumulatee : bat as the internal <

TOWBLS AND 8RBST8. M^

Mve been relieved^ and the skin placed in a more favoraUe stata
lor perspiration, this last commonly ensues, and Nature reHevee
herself. Should, however, perspiration not take place, and in-
stead of it, a return and continuation of the dry feverish skin, the
wet sheeting is recommenced as before ; and so on every five or
nx houn perhaps. It should be remarked, that in complaints
which a high degree of fever accompanies, it is generally neces-
sary to employ only three or more blankets for a covering.

*' This is the ordinary mode of applying the wet sheet in acute
disease ; and its application is only modified in frequency, accord,
ing to the intensity of the feverish or inflammatory symptoms.

*' Among the advantages of this safe, simple, and refreshing
means of reducing fever and inflammation, is that of not causing
any actual loss of strength to the patient, as by bleeding and
strong medicines ; and, as a necessary result, it is not attended
by long convalescence or debility.

^' But in chronic diseases of long standing, a variety of modifi.
cations are called for, both with reference to the symptoms origi-
nally presented, and to those which arise in consequence of the
water treatment.

" Patients often present themselves in whom the vital energy is
so woefully lowered by long disease and bad nutrition, with bad
blood, that any considerable amount of stimulus would prove too
much for their powers. These persons would never at first get
warm in a cold wet sheet, because, as this withdraws the animal
heat from the surface, the internal parts do not possess vigor
enough to labor to supply that which has been abstracted. The
patient, therefore, remains cold and miserable, and is, moreover,
liable to have the head congested and headache follow on the wet
sheet. In such cases, — and they are to be judged of beforehand
by close examination of the peculiarities of the patient, — ^it is ex-
pedient to wring the sheet out of warm water, and have it applied
around the body at a temperature of about 70° or 75^^ ; a tem*
perature which, as it does not suddenly abstract a large amoont
of heat from the debilitated body, gives the latter a smaller shock,
and more time and opportimity to supply, by the action of the
internal organs^ that which has been lost on the external surfhce.
Giradually, as, by the aid of drinking water, and by the reduction
of irritation by the sheet, the internal organs and the skin recover,
aad tlie palaent acquires appetite and power of blood-making, the
•miperature of the sheet is then lowered until it oomes to be a|^

PACKING IN DAMf

{died quite t>old, by which time the heat-begetting power of iImi
body equals the heat- withdrawing power of the sheet ; after whieh
the balance is changed, and the body generates more caloric than
the sheet can withdraw in the time usually given to lying in it.

'< For a similar reason, it is necessary in some instances to ap
ply the wet sheet only over the trunk of the body, leaving the
extremities, or at least the legs, with the dry blankets around
them. For there are persons whose organic energy may suffice
to supply the surface immediately over the vital organs with ca-
loric, but would fail to do so with regard to the limbs, which are
more distant from the active centre of vitality. The sheet ia
then made to reach only to the hips ; and this is persisted in until,
as in the former instance named, the appliances of the cure in*
crease the amount of organic energy in the body generally. As
this is in progress, more and more of the sheet is gradually ap-
plied over the limbs. As a general rule, it is better not to include
the feet for the first few times of packing in the sheet ; the ex-
ceptions being those individuals in whom there is either a great
amount of feverish heat, or the nutrition of whose body has not
been much encroached upon by long disease. This necessary
modification is practised by Pbibssnitz to some extent.

'< It is not unfrequently necessary to exclude particular portions
of the trunk from the operation of the wet sheet. Thus, in asthma,
for example, the patient is ofhimes able to bear and derives the
greatest benefit from the remedy, when a dry towel is placed be*
tween the skin of the front of the chest and the sheet ; when
otherwise he would be unable to get warm in it, and the difficult
breathing would be most distressing. Where also the heart is
nervously irritable, the same application of a dry towel oyer the
region of that organ is found to render the sheet more bearable
and efficient for good ; when the sheet becomes warm, the dry
towel can be put at the side in 'some cases. But this only applies
to nervous disorders of the contents of the chest ; all tft/IaiRMo-
tory diseases there, from a simple catarrh to the most serious states,
require that the sheet should be in immediate contact with the
surface of the chest.

'^ There is no case in which this indirect application of the
sheet to the stomach and bowels is desirable ; it would seem that
that part being the starting point of almost all ailments, both bean
and requires the full operation of this most powerful and wottdar-

TOWSL0 A1U> 8HUSTS. 987

working agent in the water cure. The sheet will always be
found first heated over this region.

" The time in which it is necessary to remain in the wet sheet
must vary with the powers of the individual submitted to it.
Suppose a patient to be forty or forty-five minutes before he feels
tiioroughly warm in it, it is generally advisable to leave him for
an hour and twenty minutes, or an hour and a half from the first
packing. The accumulation of warmth then produces sufficient
circulating power in the skin to re-act upon the subsequent ablu-
tion in the shallow bath or dripping sheet. Moreover, this slow,
less in warming in the sheet implies an inveterate degree of irri-
tation and oppression in some internal organ, which therefore
requires a full quantity of the soothing and derivative effects of
the remedy in question.

" When, however, the patient speedily — that is, in ten or fifleen
minutes — ^gets thoroughly warm in the packing, an hour is the
outside time requisite fbr him to remain. There are some cases
where even this is too long, and they are known by headache,
swimming, and sensations of fainting, showing themselves. In.
these cases, the irritation to be removed not being of that inveterate,
kind which interferes with blood-making and heat-making, caloric
soon accumulates, and to such an extent as to cause the sheet to
pass from its soothing to its irritating and depressing stage of
agency ; and the pulse falls so low as to cause irregular circula-
tion in the brain, and the phenomena above mentioned.

" Between these extremes of peculiarity as regards the action
of the wet sheet, there are numerous shades. But to detect any
of them, and thus to obtain all the good available from the re-
medy, requires not a small amount of medical knowledge and
experience in the practice of the water cure.

" As one great result of the wet sheet is to produce augmented
and healthy secretions from the mucous membranes — especially
the digestive — the state of those membranes should be accurately
examined previous to ordering it and during its use. It is by
virtue of this power that it effects such wonders in some cases
of obstinate constipation.

" The secretory agency of the wet sheet alluded to points out
its impropriety— or the care with which it must be used — in all
oases where the feebleness of the bowels readily leads to exhaust-
iBg diarrhosa.

** So long as there is internal irritation to remove, the patient
16

ass THE SITZ BATH.

goes on daily gaining power of speedily warming in the sheet,
and the time fi>r his remaining in it consequently diminishes.
But when irritation is subdued, the wet sheet, if continued too
long} tends to produce the symptoms of depression already men-
tioned ; the patient does not feel comfortable in it, though it be
warm ; he gets out of it weary and weak, and his head begins to
suffer.

" Many curious phenomena take place in some patients by fre-
quent use of the wet sheet ; amongst the most singular is that of
its becoming of a beautiful rose,color. This will sometimes con-
tinue for a week or two, then cease, and in a few weeks return
again. In other cases, the sheet is found, when taken off the
patient, after an hour's packing in it, to be glutinous, and to have
extracted foetid matters from the skin."

§ 3. The Sitz Bath.

In one of the forms of administration, this is decidedly a lower-
ing bath, and is admirably adapted for the treatment of active
irritations, as well as conditions of obstruction ; so that it is
applicable in almost all cases of chronic, as it is in very many
of acute, disease.

" The sitz bath is used either as a ionic or derivative. In the
former case, it is taken cold, and for a time varying from five
to fiAeen minutes, seldom exceeding the latter period.

" The rationale of its operation in this character is sufficiently
simple. The stimulus of the cold causes the blood-vessels of the
part and neighborhood to which the water is applied to contract,
and thereby rid themselves of any excess of blood : and as this
stimulus has not been carried to a great extent, there is very lit-
tle subsequent return of relaxation in those vessels ; still there is
some ; and it is for this reason that it becomes necessary to apply
the stimulus again afler short intervals ; short sitz baths always
require frequent repetition, sometimes as oflen as six or seven
times in the twenty-four hours. It will appear, from the above,
that the short or tcHlic sitz bath is applicable in all cases where
there is an enfeebled or congested state of the parts contained
within the hips ; for instance, in excessive menstruation, leu-
oorrhcea, loss of muscular tone, and protrusion of the lower
gut, &c.

"It is, however, more especially for ita derivative effect that

THE SITZ BATH. 339

Ae sitz bath is most frequently employed. The class of disor-
ders for which such effect is desirable is far more numerous than
those in which the tonic result is wished ; and it includes some
phases of brain congestion, obstructions of the liver, congestion
of the stomach and its nerves, stoppage of courses, and constipa-
tion of the bowels,— diseased states which include all the forms
of digestive and nervous complaints. Here the stimulus of the
cold is applied so long, that the blood-vessels of the parts contained
within the hips, after a violent tpnic contraction, fall into a state
of great consequent exhaustion and relaxation, whereby a large
quantity of blood is admitted and retained in them. The result is
doubly advantageous ; for first, a mass of blood is drawn from the
upper organs of digestion, the liver, stomach," &c., and even from
the head, whose obstruction and congestion it therefore relieved ;
and secondly, this blood so made to congest in the lower organs
of digestion, and in the genital and urinary organs, secretes the
matters peculiar to those parts, and thus the bowels are made to
act, and the monthly evacuation of females is removed, and the
functions of the kidneys and bladder are promoted.

" The temperature at which it is fit to take the sitz bath is
important. Its tonic effect, as already explained, is best and
indeed only obtained by the cold degrees, that is, under sixty
degrees. The degree at which to obtain the derivative effect will
vary with the organic capabilities of the patient, and these the
physician must ascertain by previous investigation. It must also
have reference to the patient's power of taking exercise after it ;
for if he remain cold for want of exercise, the tonic and not the
derivative result will ensue ; and it has been shown that the cases
for these are diametrically opposite. Patients in a very low con-
dition of vital activity, but in whom it is desirable to produce
derivation of blood to the lower organs of digestion, should in the
first instance be submitted to water of a tepid temperature or
nearly so, and the degree should be lowered as the strength in-
creases. The amount of derivation in such event is not so great
nor so permanent as when water at forty or fifty degrees is used :
but a judicious practitioner will suit his remedies to his patient's
power, and not go by blind rules. The Water Cure is the cold
water cure only in time and place, and where the individual
peculiarities permit, or the patient has been brought into a state
to benefit by it. .

In applying the sitz bath in its ionic character, it is desirable to

880 HOT AND WARU FQSCBIVTATIONS.

importance. Where the symptoms indicate a purely i
iory state of any of the viscera — when, for instance, mucous indi-
^estion prevails — ^the temperature should be high, nearly at the
bailing point : the object then being to counterirritate, to draw
blood to the surface, in doing which the nerves of the skin are
vehemently stimulated. But when the visceral irritation is of a
nervous character, and therefore capricious in its phenomena, it
behoves to apply the fomentations only warm, so as not to excite
but soothe the nerves of the skin : for if you excite them, the ex-
citation will be propagated to the brain, and produce malaise
there, and sometimes will even be a means of increasing the vis»
ceral irritation it was intended to subdue. I have often seen fo-
mentations to the abdomen, improperly tempered, induce severe
Jieadache, throbbing and restlessness, the irritation produced on
the skin being promulgated to the viscera and the brain^ In
more vehement inflammatory action within, such a reflection, as
it were, back on the nervous centres from the skin, is not likely
to occur, the irritation in these being already very great and of a
decided character. These are the leading indications as to tem-
perature, and the gradations between the extremes of pure in-
flammatory and nervous disorder must be lefi to the discrimina-
tion of the practitioner.

Hot fomentations should never be applied to the abdomen ex-
cept when the patient is in the recumbent posture, and can take
rest after them. Being a lowering remedy, especially in dimi-
nishing the excitability of the brain, exertion of the limbs should,
upon no account, be allowed immediately subsequently on their
application. Indeed, it is better that sleep should be taken : and
hence, bedtime is the best time for them. They should never be
applied within at least two hours and a half after a meal> with
the digestion of which they would otherwise interfere. The du-
ration of this process varies from twenty to sixty minutes every
dayj or every second day, according to the indications afl^rded by
the degree and kind of internal disorder.

Fomentations, although directly lowering, are, indirectly, a
strengthening process. The inflamed stomach of a patient acts,
by sympathy, as a spur to the function of the brain, which there-
by exhibits a degree of impuMve energy that passes for power .
the patient can walk and talk quickly, has incessant desires to
move, dec. : but all this is fictitious strength, just as the energy
imparted by alcoholic liquids or tonic medicioes ia fictitious. Fo

HOT AND WARM FOMSlfTAnOKS. Ml

mentatioiis, by redueing the inflammatioo of the stomach, witii.
draw the spur from the brain : and the patient, feeling in conse-
quenoe much loss of his locomotive propensity, says they are
weakening him. But they are plainly only reducing his brain
to its actual and gemdne level of strength by taking from it the
moibid stimulant which gave it fictitmu power. And, mean-
time, the digestive viscera, being strengthened by the reduction
of their inflammation, will, as they improve, afford such natural
sthnulus to the brain as will give it a sustained energy. I dwell
upon this, as patients often make complaint, in the first parts of
the water treatment, that they are weaker : these fomentations,
and the wet-sheet packing generally forming those parts ; where-
as they are only weaker for a time in the animal nervous system,
but are becoming permanently stronger in their nutritive nervous,
system ; and tluU is the great consideration : strong viscera are
always accompanied by strong brain and spinal cord. It is, how.
ever, necessary to mark well the point at which to discontinue
the use of this remedy ; if they be continued one day beyond the
reduction of active irritation, they really weaken, and induce the
headache and other symptoms already mentioned, which attend
their employment at an excessive temperature. In this respect,
the pulse is the best indicator : when it has lost sharpness and its
jerky character, hot fomentations are superfluous, and their con.
tinuance would render Jt small, weak, and exceedingly irritable.
Hot and warm fomentations form an excellent commencement
to the treatment of those cases, where with active irritation exist-
ing in the viscera, there is such a want of vitality and blood in
the entire body as to render the immediate employment of the
ookJ remedies adapted for the reduction of that irritation impossi-
ble or hazardous. I have constantly found that in old persons,
delicate females, bloodless and greatly debilitated patients, espe-
cially in those affected with bronchial and, asthmatic disorder of
the lungs, it became possible to apply the colder remedies of the
water cure by first using these fomentations for a period. A cer-
tain amount of the mal-distribution of blood within was thereby
overcome, and a better circulation to the exterior thereby attain,
ed, which enabled the skin to re-act upon the cold wet sheet,
when it would otherwise not have done so, without much sense
of misery, at least. Extreme congestion and extreme general
weakness may be thus coaxed, as it were, in commencing the at«
tempi at self^restoration, whilst other means would have over*

39*2 PACKING IN DAMP

whelmed them. By their aid I have often been enabled to begfa
the treatment of delicate persons in the middle of winter, who
must else have postponed it until summer heat assisted the skin.

When there is a good amount of feverishness present, hot
fomentations, applied for half an hour immediately <ifter a wet-
sheet packing and the rubbing sheet or shallow bath, are excellent
means for seconding the febrifuge qualities of the packing, and
the two together are almost sure to induce perspiration and
terminate the fever.

Local fomentations with hot and warm water are not often re-
quired in chronic disease. In the exasperations 6^ gouty or rheu-
matic infiammalion of the joints which occur in the course of the
general water treatment, they may be used with advantage, at a
low temperature. At the same tenftperature they are applicable
in certain skin diseases, particularly in chronic erysipelas ' Ih
bad paroxysms o^ neuralgia, they afford relief applied at a high
temperature, the general fomentation being at the same time
employed. * '

When, in disorders o^ obstruction, the eiforts induced by the
treatment have gone to the length of causing some degree of fever-
ishness and nervousness, the application of warm fomentations at
bedtime reduces these symptoms, and thus allows the main treat-
ment by the tonic and stimulating processes to be continued.

§ 2. Packing in Damp Towels and Sheets.

The same remark which has been made regarding the loeaken-
ing and lowering effect of fomentations applies to this process ; it
is directly lowering, but indirectly strengthening ; it reduces
excess of blood in one organ in order to send sufficient to another,
which has too little. Still, it materially reduces the circulation ;
and where that is very feeble, from deficiency of blood in the
whole body, it requires care in application. Hence I have found
it necessary to introduce (for it is not spoken of in works on the
water cure) the use of towel as well as sheet packing. In very
delicate and bloodless patients, I generally begin packing with a
single towel placed down the front of the trunk : and they will
be able to warm this, and not have the circulation so lowered as
when the whole body is enveloped in a damp sheet. By degrees,
as the blood begins to circulate better, I put a tdwel on the back
as well as the front of the ti'unk, and so gradually and safdy gBf

TOWSLS AUD SBBET8. 381

Ob to the einployment of the sheet over the whole body. Anothef
advantage of this partial packing at first is, that the arms are
free, and this is no slight consideration to nervous and delicate
persons, to whom the constrained and helpless position of the
entire sheet packing is sometimes very disagreeable, and might,
by acting on the nerves, be harmful. By the use of fomentations
and the towel packing, I have been enabled to undertake and
successfully raise up patients whom, without them, I must have
altogether declined to treat.

The novelty of such a process as wet-sheet packing past, it
. becomes one of the most agreeable, because one of the most
soothing, of all the water remedies. By it the nerves proceeding
from the brain and spinal cord to the skin, and which are mor.
bidly sensitive in all chronic diseases, are relieved, for the
moment, from the irritation of the air, and placed in the mild
atmosphere of warm vapor which is made by the heat of the
body acting on the moisture of the sheet. Instead, therefore, of
irritations proceeding from the extremities of those nerves, spread
over the skin towards the brain, this last is quieted by the tem-
porary withdrawal of them ; so much so, that the patient ordina-
rily sleeps whilst packed, and will sleep then when he could not
sleep without it. On coming out of it, therefore, the nervous
energy of the skin having accumulated strength by the rest thus
given to the nerves, is in the best condition to react upon the bath
which follows. Add to which, that the quietude of the brain has
freed the viscera from irritations which it sends to them in the
ordinary progress of chronic disease, and thus they, too, are in
the best condition for reacting on the external application of cold.
The whole body has been rested, its organic powers have been
accumulated, and it can now respond to the stimulus to be applied
to its external surface. Accordingly, the shallow or sheet bath
is applied immediately, at an appropriate temperature, and the
result is a rush of blood to the skin ; a rush, be it remarked,
produced by the organic powers of the body itself, and not liable,
therefore, to be followed by a reflux. This process repeated day
after day, and sometimes twice daily, at length Jixes a quantity
of blood in the blood-vessels of the outer skin, and thereby
reduces the disproportionate quantity which was congested in the
inner skin or mucous membranes.

<< Scientific medical practitioners are aware that there are two
ways of giving health and strength to a frame laboring ondei •

am THE Sweating fbocbss.

dncing derivation in favor of the obstructed vitcus. . How the
relief of this diminishes the symptoms which constitute the dis-
cases in question will be seen under those particular heads.

Patients who come to try the water cure have generally been
told by their previous medical advisers, that " they may try the
sweating process, but upon no account the wet-sheet packing."
This has happened so often, that it has ceased to amuse or
astonish me by the ignorance of physiology displayed in it. The
truth is, that if there be one process of the water cure more easily
abused, and therefore more dangerous than another, it is the

. sweating process. Compared with the wet-sheet packing, it is a
hazardous remedy, for it excites and taxes the nervous and circu-
lating systems in an extraordinary manner, whereas the wet
sheet soothes them in an equally extraordinary manner ; and J
apprehend that the patients who require soothing are infinitely
more numerous than those who can bear to be excited in the
head and about the heart. Accordingly, the sweating is to be
avoided whenever there is activ.e irritation of the viscera or
feverish symptoms of the skin, pulse, mouth, &c. Thus it is im-
proper in common cold and influenza; it aggravates them,
whilst the wet sheet is rapidly beneficial.

<< In most cases where there is a determination of blood to the
head, or where there is reason to suspect the existence of chronic
disease in the brain, the sweating must be practised with very
great care and discrimination. Where there is extensive chronic
inflammation in the digestive mucous membrane, — in some casej^
of hypochondriasis, irritability of the heart, nervous debility, (fcc;,
this process must be deferred, or not used at all. Where these
contra-indications do not exist, and the sweating still produces a
loss of flesh, or an increased state of irritability— ^-when the patient
does not feel well, and obtains full re-action after the bath, in
such cases it is advisable to discontinue it.

" With the repetition of this process, great changes take place;
at first the perspiration is small in quantity, clear in its nature,
and difficult to be produced ; as the patient advances, it becomes
more profuse, and impregnated with the most disagreeable odors, —
viscid and glutinous, — of a dark yellow and even brown color,
and sour, foetid, &c., in. its smell. When these morbid pheno-

, mena appear, the perspiration may be considered of a critical
nature. As a general rule, where there is no evident reason
why this process should not be used, sweating, followed by tbo

THE SWEATIJi:^ PEOCESS. 85$

Isold bath, is not debilitating ; what is lost in one way is repaired

in another. The appetite is so much increased, and the functions
of the skin and digestive organs so improved, that the loss of a
little fluid by sweating has only a salutary effect. Fat is replaced
by hard elastic flesh, and languor and debility give way to a state
of cheerfulness and activity.

" It is necessary to bear in mind that it. is not the mere pouring
out of sweat that relieves or cures disease. What is desired to
be done by the sweating process, is to rouse the system to those
efforts of cure which constitute the peculiarity of treatment by
the water cure. The sweat poured out is only an indication that
these efforts have been made ; in the same sense that the crisis is
only an indication of similar efforts on a more continuous scale.
Hence, if we find that the process taxes the patient's powers, and
especially his head, it is proper, for the first time or two, to take
him out of the blankets and use the bath, when a considerable
heat has accumulated in the skin, and before any sweat has flowed.
In this manner we are enabled to coax, as it were, the skin into
sweating, without exciting the brain and nerves in a harmful
way ; for after a few trials of this kind, the skin opens and gives
out its fluids, without any injurious straining of the system.

" Another way to counteract the headache which sometimes
attends sweating, is to place a towel well wrung out of cold
water, over the stomach and bowels, and then envelope the patient
for the process. A brisk walk, or a light meal, taken two or
three hours previously, ofttimes too curtail the process ; but it is
generally better to obtain the sweat without those aids ; it is then
more entirely the work of the system ; there is less o^ forcing in
it ; it is more natural, and therefore more beneficial."

The ilsual water-cure mode of inducing perspiration is by ac-
cumulated blankets tightly bound round the patient. • I confess
to have been strongly prejudiced in favor of this mode and against
any other, from a belief that the general excitement of the sys-
tem, as shown in quickened pulse, &c., and which it is so essen-
tial to produce, could only be roused by the gradual accumula.
lion of the body's own heat in the coverings alluded to. I have
subsequently had occasion to throw aside this prejudice, in
consequence of having ascertained, by repeated experiments,
that a hot air bath (from which, however, the head is carefully
excluded) causes all those phenomena of nervous and circula-
lory excitement in equal degree ; the pulse in both cases rising

856 THE SWBATUfO PR0C£8S.

fjnom twenty to thirty beats in the minute, until the breaking out
of perspiration. And not a small advantage of this air bath is,
that it occupies from thirty to forty-five minutes, whilst the blan-
ket packing is a business of three to five hours. Still, the head
is taxed in both ; and it is therefore sometimes advisable, as al-
ready stated, to begin by simply heating the patient in blankets,
and by degrees advancing to the full perspiration. Where it is
desirable to actually 'purge the skin, as in chalky gout, in old rAeu-
matism, and sometimes in dropsy, the air bath has the decided ad-
vantage of causing and keeping up a more profuse sweat. On
the other hand, when we only desire the sweat as an evidence of
excitement, and the warmth of weather curtails the blanket pro-
cess, it may be as well to employ it.

But this hot-air bath, with the exclusion of the head, is a very
different thing from sweating, as has been done, in rooms heated
to 150^ of Fahrenheit, the patient hreatJung air at that degree of
temperature.

" The inhalation of hot and dry air is in every way deleteri-
ous. It carries off all the moisture that ought to lubricate the
windpipe and air passages of the lungs, and thus renders the mu-
cous linings of those parts especially sensitive. Not only so, the
immediate contact of the stimulating atmosphere with the sensi-
tive lining of the air-tubes was never intended by nature, and the
mucus is poured out for protection from such contact. Accord-
ingly, this hot, dry air, by abstracting the moisture, tends to pro.
duce cough and sense of stricture about the chest. This was the
leading objection to the use of Arnott's stove in chambers, as all
may remember ; and it was a very valid one.

" But farther, it is in complete opposition to the principles of
the water cure to inhale heated air at all. Rightly proceeding on
the doctrine that the blood is to be rendered healthy, feo as to
permit the body to work its own restoration, the admission of pure
cool air into the lungs for the purpose of oxygenizing that fluid
is above all essential. Now, hot air being rarified, does not
contain one half the oxygen that cold air does, and the blood con-
sequently loses just by one-half its vivifying and strengthening
agency : the dark blood from the veins is not sufficiently changed
by the air, and a blood unfit for the purposes of life is allowed to
flow through the body, and especially in the brain, where it con-
gests, and produces the tense headache that attends the inhalation
of hot air. The conseouence of all which infallibly is, that when

TRK SWSATUVO PK0GS88. 967

riieumatismy and one or two other complaints, are relieved by
this hot-air sweating (and they have been so relieved), their return
may be relied upon ; no cure has been effected, because the very
first principle of cure, — ^the formation of a healthy, rich blood, to
enable the body to effect its own restoration, — has been sinned
agcunst. it is one of the abuses of the water cure that ought to
be deprecated by all who understand that cure and wish its
success."

An essential sequence to the sweating process is a cold bath,
either the shallow bath, or the plunge or douche. The object is
to restore to the skin the tone which it has lost, for the time, by
the direct application of heat, and by the excessive play of its
function in sweating. The water should therefore always be
cold : and for another reason. It is desirable to make an impres-
sion on the centres of the nervous system, in those maladies in
which the sweating process is pro{)er, and this is most effectually
made by the impression of cold on the skin at the moment when
it holds an immense amount of heat, and is ready to transmit
quickly and precisely the stimulus of the cold : the brain, mean-
while, having been put into a position to receive and readily react
upon any such impression on the extremities of the nerves of the
skin. The result of the impression and reaction is an amount
of light and exhilarating feeling, that cannot fail to act favorably
upon the parent mischief, and is, at the same time, a symptom of
its relief. In old standing palsy, I have employed the douche
afler the sweating with much benefit : it is much more effectual
than the plunge baths, the action of which is not so striking as
might be expected.

I will not stay to answer the very old and long exploded objec-
tion to the application of cold water when the skin is damp with
perspiration procured in a passive state of the body. Old ladies
of both sexes, who have never seen it employed, hold by the danger
and destruction that attend it ; but their opinion may be profitably
exchanged for that of persons who, like myself, see it done every
day with no particle of danger, and with considerable benefit.
The hot, comfortable blankets in which such old ladies rejoice,
require, as I have said, more care in administration than the oold
oath which follows them.

IM FOOT AND HAI«D BATHS, AND

§ 0. Foot and Hand Baths, and Minor Ablutions and Fitic«

TIONS.

Whilst the preceding processes of the water treatment have
been mourned over as most dangerous, foot haths and hand hatha
have heen ridiculed as most inert. Practical inrestigation, how-
ever, sets aside this objection ; one instance in which a cold foot
bath has relieved a nervous headache or toothache, or in which it
has warmed the feet, is worth a thousand assertions about the ab-
surdity of such a remedy from ignorant inexperience. Besides,
l^ysiological facts are in favor of its power in acting sympatheti-
cally on the function of the brain and spinal cord, and, through
them, on the viscera. The feet and hands, the soles and palms
especially, contain an accumulation of animal nerves and of blood-
vessels which is not equalled by any portion of the exterior of the
body. This is necessary to them as the organs of touch and pre-
hension, and of station and walking. In these characters a very
large quantity of animal nervous matter is essential to them, in
order to bind them by the closest sympathies with the great cen-
tres of thought and volition, so that their applications and move-
ments may be accurately directed by the mind. Disease shows
this close sympathy : in no part of the body does pain appear in
more exquisite form than in the maladies of the feet and hands, —
witness gout and whitlow. Lock-jaw, an evidence of the most in-
tense irritation of the brain and spinal cord, is more frequently
induced by wounds of the feet and hands, particularly the former,
than by those of any other part of the frame. The least tickle-
some persons prove exceedingly so when the operation is per-
formed on the soles of the feet and palms of the hands. When
the brain is oppressed and stupor has overcome it, to what part
are stimulating remedies applied for the purpose of relieving its
circulation, afler all other applications have failed ? To the con-
geries of animal nerve^ in the sole of the foot. When the brain
is faint, where are reviving remedies most effectually applied ?
To the congeries of animal nerves in the palms of the hands.

These considerations are worth recalling when the efficacy of
Soot and hand baths is in question. They aid the numberless
facts which attest the power of those remedies m relieving a vari-
ety of nervous conditions — ^pain, lassitude', fidgets, &c., which
show an irregular or congested* state of the circulation in the
brain and spinal cord. But inasmuch as they remedy the oiron

KINOL ABLUTIONS ANH .FRICTIOIVS. 350

Ifttion in those animal nervous centres, they also act upon the
ganglionic nervous centre in the digestive organs ; and it is found
accordingly that flatulence, nausea, sinking, gnawing and other
morbid sensations about the stomach, are materially relieved by
foot and hand baths. And with this double relief, freshness and
alacrity are imparted to the frame generally. By this beneficial
operation they assist the more general means of the water cure^
although themselves only palliative of particular symptoms. YU
how necessary is this subjection of smaller symptoms in the
course of chronic disease ! Sometimes they are the coups d'^n-
glcj which exasperate the leading malady into an incurable
inveteracy.

The shock and friction of the feet and hands in these baths
has, for a secondary result, the attraction and retention in those
parts of a great quantity of blood, and, consequently, of increased
temperature there. In fact, a cold foot bath of twelve or fifteen
minutes, followed by a walk of half an hour, is the most certain
way to warm the feet that can be devised ; just as, per contra,
the most certain way to ensure cold feet is to soak them in hot
water. The same applies to the liands. When the patient is in
condition to take it, a walk is necessary to obtain the circulating
redaction alluded to. When he is not, and the action of a foot
bath is desirable, I usually order some mustard flour to be added
to the cold water, and prolonged dry friction with rough towels or
brushes to succeed the bath : this seldom fails to cause re-action
and warmth. In either case^ the warmth remains for several
hours. Very frequently I have heard persons say, they have not
known cold feet sinbe they began to take cold foot baths.

It is necessary to bear in mind, that the water should not be
deeper than the feet. The object is to gradually warm the water,
and thus render the re-action gradual and permanent ; and this
would not happen with too large a quantity. A small quantity
of snow rubbed upon a frost-bitten part will gradually restore it,
'vhen a large quantity of ice, or, on the other hand, boiling water,
would annihilate vitality at once. Itsis preferable that the feet
should be rubbed by an attendant and not against each other,
especially in nervous and debilitated persons, in whom the exer-
tion would be likely to mar any good to be anticipated from tne
re-action.

Partial ablutions and frictions are beneficially employed cm,

MO WATEB DBIIVXINO.

Other parts of the hody against individual symptoms. The
haih is an instance : when the hrain is wearied and the whole
body fatigued, it is most reviving to keep the back of the head
up to the ears in cold water for five or eight minutes. BeycMid
this I have not found, from this topical bath, any of the astound-
ing results that have been attributed to it by some writers. Where
there is the smallest tendency of blood to the head, it, at least,
does as much harm by the strictly horizontal position it requires
as it can do good by the abstraction of heat from the scalp.

In local spasmodic pains, continued friction with the hand and
constantly renewed cold water is very effectual ; a cloth fre-
quently dipped in the water will do, but on the whole the hand is •
better ; why, it may be hard to say. In this way I have put an
end to sudden and severe neuralgic pains of the knees and
shoulders ; and even to bad nervous headache by frictions on the
nape of the neck. I have relieved spasmodic state of the urethra
by friction and ablution of the loins and downwards, where
the nerves going to the urinary organs are given off by the
spine.

In relaxed sore throat, relief will be found from pouring a stream
of cold water on the nape of the neck and letting it run over to
the front of the throat, the patient holding his head over a basin.
This should be continued for three or four minuteg ; wet friction
should then be used for eight or ten minutes ; and the whole pro-
cess repeated twice or thrice a day.

§ 10. Water Deinkikg.

All the preceding details of the water cure effect a change in
the nervous energy of the body and in the distribution of its
blood. We now come to those details which more immediately
operate in changing the quality of the blood ; and these are v/ater
drinking, food, air, and exercise.

I have already (page 317) given my reasons for repudiating the
indiscriminate prescription of large water drinking in the cure
of chronic disease. A great number of cases — of nervousness,
for instance — depend on irregular distribution of blood alone.
In such, large quantities of water are decidedly injurious, they
augment the nervousness tenfold. In another set of cases — ^those
with blood tending towards the head — they are decidedly danger-
ous. Again, when the patient has a very irritable pulse, and ia

WATBR X>&INKIM«. 802

ooQstUutiooally a person of vivid sensations, large water drinking
is rarely admissible. From three to six tumblers daily are the
limits in such instances as the above ; and that should be taken
in vei^ divided quantities, a wine-glassful at a time being often
as much as is good. In all these cases, as well as in some of the
worst instances of nervous indigestion, the great centre of the
nutritive nerves is so exquisitely sensitive, that the shock of even
half a tumbler of cold water upon the stomach is transmitted to
the brain and there causes giddiness, confusion, nervous aching,
&c., and this the more certainly the lower the temperature of the
water. On this account I have now and then raised the water
to 55° or 68°, when the drinking of it was indispensable, until
the nerves of the stomach became more able to bear the natural
temperature ; and have been consoled for the heresy therein im-
plied by the benefit therefrom obtained. For, as the external
remedies derive from the interior to the exterior of the body, the
stomach becomes less sensitive, and both the temperature and the
dose may be carefully increased . This stimulating property of
cold water taken internally should always be kept in mind.
Most of those who know nothing, but assert a great deal, about
the water cure, say that water drinking lowers the powers of the
body, whilst many professors of the water cure order such extra-
vagant doses of it as to make one think they consider it a very
weak agent. . Both err in not recognizing the stimulating charac-
ter alluded to, and which requires due apportionment to individual
cases. The cold of the water stimulates the blood-vessels of the
mucous membrane, and expels the blood from them. For this
reason it is that it is necessary to drink some water after
every bath, this last -always causing- a flow of blood, for the
time, towards the internal membranes, to remedy which,
cold water is drunk and exercise taken immediately. In-
deed, without these precautions, the external processes would
fail in half their good effect, qt be positively harmful. But if the
blood-vessels of the mucous •membrane are excessively irritable,
this stimulation by the cold, may cause violent reaction in them,
and thus actually increase the quantity of blood in them. Here,
then, is a reason for care in the quantity of cold conveyed by the
water to the stomachy Further, the cold of the water stimulates
the extremities of the nerves which come from the brain and
spinal cord to the muscular coat of the stomach, and convey sen-

•ations to and from those parts. The result of this stimulatfon
17-

M9 WATEE DRUfXUTfi.

is oontraction of the muscular coat, and this contraction consiUuiM
hunger, one of the well-known consequences of cold water drink*
ing. But here, again, if too much cold be applied, this oontraction
will amount to spasm of the stomach, an event I have witnessed
in not a few instances of persons who treated themselves bj
certain water cure treatises, which record the wonderful effects
of wonderful imbibitions of cold water.

Added to the stimuhis of cold is the stimulus of weight, which
80 heavy a liquid as water cannot fail to afibrd ; and together with
the weight, the hulk should be considered. It is true, that absorp-
tion of the water speedily takes place ; but it is nwre or less
speedily, according to individual peculiarities. Very many suf-
ferers from nervousness and nervous indigestion will give marks
of very slow absorption, by rejecting a portion of the water after
an hour or more. Absorption is quickened by exercise : but if
the patient be distressed by too large a quantity of water taken
at once, exercise becomes a painful or impossible thing to him.
Between the inordinate stimulation of cold and of weight and
bulk, the stomach distresses, and almost paralyses, the brain and
seat of the will ; whereas, if taken in proper quantity, water is
one of the most effectual sustainers of the animal nervous system
and of locomotion ; many persons, whom walking before break-
fast would distress, are enabled to do so with comfort and alacrity
by taking small draughts of cold water. Here, then, is another
reason for discriminating in the prescription of water drinking.

Supposing the water absorbed and carried into the circulating
• olood, it then proves a stimulus to every capillary blood-vessel in
the body. It thus quickens the great functions of nutrition, of
depusit, and of waste, which are carried on in these minute and
mysterious extremities of the wondrous circulating system.
Quickening their office, it also quickens that of their great
centre— the heart, and the pulse becomes more rapid with copi-
ous water drinking. But as a large proportion of the capillaries
of the body exists in the brain and spinal cord, their increased
function in those organs proves a source of augmented nervous
phenomena, the sensations becoming generally more vivid, and
processes of digestion, &c., going on in the viscera being felt,
which the brain had previously failed to recognize. Some excita-
lion of the nervous system is unquestionably unavoidable in the
oourse of rousing the self-restorative power of the body ; but the
I have briefly offered of the mode in which water

WATER DBINXnifl. 8dt

drinking operates on the nervous and circulating systeoM may
warn persons, as yet uninformed of tlie science of the water cure,
from the folly and hazard of prescribing or taking the huge dosea
of water which were at first thought and taught to be essential in
an cases of disease.

Still, as I have all along repeated, there are cases of Imjndf
obstructed funcUofij in which it is both safe and necessary to pre-
scribe copious water drinking. In these, nothing short of consi-
derable stimulation of the nervous and circulating systems by the
cold, the bulk, and the action in the capillaries implied by the
water, suffices to bring into play the conservative power of the
body. But there is nothing to fear for the head or heart in such
cases ; the functions of both are far too much oppressed to be
suddenly driven to the other extreme. Yet in no case is it de-
sirable to swallow the twenty or thirty tumblers before breakfast
which we are told are so delightful and refreshing ; it is to be
hoped they were tumblers of short measure.

From what precedes, it is plain that water should be drunk in
that state of the stomach which best fits it to receive and to
transmit its stimulus, as well as to absorb it most readily. If the
stomach does all these readily, a smaller quantity of water pro-
duces an equal result with a larger quantity in a less favorable
condition of stomach. When the stomach is empty, and has been
so for several hours, its nervous as well as its absorbent energy
has accumulated, and the water stimulates, and is absorbed with
alacrity. When the brain has been at rest for several hours,
it and the whole nervous system are in the best state for
receiving stimulation from the stomach. Accordingly, these con-
ditions obtaining for both organs in the early morning, afler sleep
and before breakfast, that time is best fitted for water drinking,
the principal portion of which should therefore be practised then.
In other parts of the day, for a like reason, water should be taken
three or four hours after meals, and after every bath or process
whatever. Ej^ercise of some sort should follow the drinking, in
order to promote absorption. If very much heated with exercise,
the water should be drunk very slowly. In most cases of mucauB
indigestum, a tumbler of very cold water taken in sips an hour
and a half after a meal, or even earlier, assists the stomach, heated
and jaded by the process of digestion, in its laborious function :
this is the only exception that I am aware of, to the rule of driiik-
ing with the stomach empty

9M AIE AK0 £X£JIC]SE.

The rubbish which is talked about water drinking causing
dropsy, thin blood, weak stomach, d^c, is disposed of in tl^
Appendix.

§ 11. Am AND Exercise.

As in the preceding article, so in this, I am compelled to anim-
advert on the indiscrimate rule, or rather no-rule, that has been
imported into thb country. Of air, indeed, it may be said, that
an invalid cannot have too much, provided it' be of the right tern-
perature and hygrometric quality ; seated or exercising, let him
take as much as he pleases. But this is not the climate for such
happy combination of atmospheric qualities, and to thrust all pa-
tients alike into all winds that may blow is heroic, but may prove
hurtful to some of them. Still, anything like *' coddling" should be
avoided ; patients should have abundance of air, and it is only
necessary to regulate well the outgoings of asthmatic, pulmonary,
and certain neuropathic persons, who should especially avoid east
and southeast winds and night air. The morning air, like the
morning sun, is the finest in its operation on the nervous system,
and that system is then in the best position, after sleep, to receive
its influence. The walk before breakfast id therefore the mos^
requisite of any in the day. The air of towns is inimical to the
cure of chronic disorders, except some rare instances of that pro-
tean disease, asthma. That of Jiills is the best, because the most
dry and the most stimulating ; and it thereby effects the greatest
changes in the blood. Low situations, and even high situations
with a clayey, retentive soil, mar very much the curative
process.

The air of rooms in which patients under the water cure sit
should never, even in the winter, exceed 65** or 58°; and even
lower is desirable. That of their bed-rooms should be ten or fif-
teen degrees lower, and indeed can scarcely be too cold. When
the body is warm with bed-clothes, air at 35« or 38^ is much
more conducive to sleep than that at 65° or 70®, to which tem-
perature some persons rai^e the atmosphere of their bed-rooms.
Everybody (especially excitable neuropathic invalids) sleeps
better in winter than in summer.

With regard to exercise, it must be regulated entirely by the
state of the patient's nervous system, and by the food he tat^
Md digests. If there be none of that Qervousfu^ ^f^h^ph i^(0

AIR AND EXERCISE. 965

tremulousness of mind and body, and if the stomach allows of the
digestion of a fair quantity of meat and other nutritious articles,
the patient ought to walk a good deal in order to dissipate the
nervous energy and the aliment. To tell persons to live low and
take constant exercise, or, on the contrary, to feed them highly
and keep them on the sofa, with the view of strengthening them
(as I have known to be attempted), is an absurdity of which one
would imagine an educated physician incapable, did we not hear
sometimes of the injunction to "walk, walk, walk," being laid
indiscriminately upon all patients alike. Only consider what
parts are drawn upon in the act of walking. You bring into play
the seat of the will, the brain, and spinal cord ; examine, there-
fore, what is the condition of thase parts, whether it be one of
irritation and excessive function, or of oppression and deficient
function ; if the former, you most unquestionably increase the
irritation by exercise of the will in long walking, just as you
would inflame your eyes by prolonged use of them ; if the latter,
you do right to urge the will into action, in order to overcome the
oppression. But when you excite the brain and spinal cord by
walking, you excite, by sympathy, the great organic centre at
the digestive organs ; so that it behoves to consider the state of
those Cleans, whether it be one of irritation and excessive func-
tion, or of oppression and deficient function. Now it so happens,
that these conditions of the digestive organs correspond with
similar states of the brain and spinal cord, and that therefore the
same rule, as regards exercise, applies. Thus, in nervous indi-
gestion, it is not well to take long walks or great exertion, for
stomach and brain are acutely sensitive ; whilst in congested
liver torpor pervades both it and the seat of the will, which should
therefore be exerted in a strong and prolonged manner. Not
only so ; exercise wastes the blood and the nervous energy of the
frame, and whence is a fresh supply to come ? From the food
which the stomach is to digest. But if the stomach cannot digest
much food ? Why, then you must not waste that which the food
and blood supply more quickly than they can renew it. And
this brings me to the proposition with which I started, that the
amount of exercise must be regulated by the nervous energy,
and the quantity of food taken and digested. I know it is pro-
posed, and in some places acted upon, to eat a great deal, to walk
incessantly, and to employ an immense quantity of the roughest
{lortion of the water cure, in all cases. Very possibly this suo

DIKT.

oeeds ; but I know it cannot succeed without a vast amount of
disagreeables to be borne by the patient ; and I also know that
cure is obtained with a regulated amocnt of those means, and free
from the greater part of the disagreeables.

With this rule regarding exercise, the practitioner will deter-
mine whether walking, riding, or driving, be the appropriate form
of it, and the amount of each. In the Seeond Part I have stated
Ihe details of this matter in each malady treated of. It is only
necessary to add here, that in all cases where the patient's limbs
are in condition to walk at all, more or less of that exercise should
be taken afler each bath ; or failing the capability of walking,
artificial exercise, in the shape of considerable friction of the
limbs, should be practised.

§ 12. Diet.

Some writers on the water cure have made a l)oast, th|t no
restrictions in diet are required in that mode of treatment. There
can be no doubt that, in the water cure, the appetite and diges-
tive powers augment so rapidly, that at an early stage of the
treatment food can be taken more freely than in other plans of
treatment : all the appliances have that tendency. But, on the
other hand, experience gives me no room to doubt that, by appro-
priate regulation of the diet to each case, restoration is secured in
much less time, and with much less of that constitutional tumult
which harsh practice rouses. Accordingly, I have to forbid
some patients the use of animal food three or four days in the
week, and others for a week together : to some I forbid all pud-
dings, even farinaceous, after meat : to others all vegetable mat-
ter but bread, &c. All this is subject for weekly or even daily
change ; and it is impossible to lay down rules applicable to all
cases. Two facts I have particularly noticed, that in some in-
stances of digestive disorder the stomach tolerates best stimulating
food, which contains a good quantity of nutriment in a small
bulk, such as meat, bread, beans ; and that in other instances it
is advisable to avoid food of concentrated stimulus, and take that
which contains smaller amount of nutriment in a larger bulk, as
is the case with vegetable matters. As a general fact, it may
be said that nervoiLS disorder of the digestive organs is less tole-
rant of bulk than inflammatory disorder ; • nothing oppresses a
nervous dyspeptic so much as a mass of vegetable matter ; whilst

DST. 967

animftl fix)d, put into an inflamed stdmaoh, causes local pain, and
exquisite restlessness and distress generally. The practitioner,
therefore, has to determine the particular state of the digestive
organs, and then choose between nutriment in a small space,
which stimulates by. its concentration, and nutriment spread over
a lai^e mass, which stimulates by its bulk. Again, as to quantity ^
he must be especially- careful on this head, as on it depends the
amount of exercise and of water processes. Here, again, it is
idle to attempt a general recommendation, except it be that it is
safer to be under than over the mark. In no part of the physi-
cian's oflice is more acuteness, firmness, and precision required,
than in this affair of diet. Persons who would shrink from the
utterance of an untruth in all other things, do not scruple to evade
and deceive in this ; as if conscious of the extremity of mental
feebleness displayed in the incapability of resisting the desire
which babies and brutes gratify without control. When in good
health and strong exercise of body, it matters little as to the kind
of food which man takes, nor is it desirable to starve ; that would
place him in the worst condition for resisting the causes of dis-
ease ; and there is some truth in the lines,

" Gross riot treasures up a wealthy fund
Of plagues, but more immedicable ills
Attend the lean extreme."

But when the " plagues " have arrived, it behoves to act upcm
the rule of giving the stomach — ^the centre and sustainer of all
plagues — as little to do as possible, compatibly with the support
of the body and with the amount of its exertions, and thus afford
it the best chance of recovering itself; which, as I have all along
said, is the. only recovery worth obtaining. This rule, then,
excludes all things that minister rather to the palate than to the
body's support ; but there are a great many good things among
those which a patient in the water cure, and who eats only for
the sustenance of his organs, may take. To show this, I append
a list of lawful articles of diet, and I maintain that it ought to suf-
fice for all except those to whom " in solo vivendi causa palato est,'*
who live but to eat, instead of eating to live. But lest things not
mentioned should be construed into lawful, I subjoin a list of
articles which are unlawful.

M8 DiST.

Dm Tablb tob Paubnts uxdbe Watbe TRXAtmit*

1. TBIHGS PBRHlfTEB.

Soups. — ^Plain beef, mutton or chicken broth, or with the addition of
carrots, young peas, cauliflower, rice, vermicelli, semoule, sago, pear
barley, or other farinaceous substances, but without other condiments
than salt. These to be taken only under peculiar circumstances of
sickness.

Fish.— Turbot, soles, cod, haddock, whiting, muUet, trout, pike, and
perch, simply boiled, and eaten with a little plain butter, may be taken
occarioTidUy.

Meat ajxd Animal Prodctcts. — ^Beef, mutton, lean pork, veal, venison,
roebuck, hares, fowls, turkeys, pheasants, partridges, woodcocks, but not
the trail, and, indeed, game of all sorts when not too old, nor too long
kept : the meat may be roasted, broiled, or stewed in its own gravy, with
a few carrots, turnips, or potatoes — further, good fresh butter, mild and
tender cheese occasionally, and fresh curds.

Vegetables and Roots. — Asparagus, artichokes, spinach, caull^wer,
young cabbage, sea-cale, French beans, young peas, tender beans (but
not the skins), carrots, mild turnips, parsnips, beet root, potatoes, rice,
macaroni, with gravy or milk, but without cheese.

Condiments. — The only condiments are salt, sugar, vinegar and lemon
juice. The two latter, with young meats, chicken and fish only.

Sweets and Fruits.— Plain puddings of milk with eggs, flour, bread,
rice, vermicelli, macaroni, semoule, sago, arrow-root, or other farinaceous
substances, eaten with butter or sugar, or the fruit of pies or puddings,
to some ices — ^further, well-ripened pears, grapes, raspberries, gooseber-
ries, strawberries, oranges, and even apricots, peaches and nectarines
occasionally, remembering always to reject the skin and fibrous parts.

Drinks.— Water, toast and water, barley or rice water, and sometimes
milk, milk and water, weak black tea, almost cold.

2. THINGS PROHIBITED.

SoTTPS.-^Soups of all kinds, unless made expressly for the patient, im-
der peculiar circumstances of sickness.

Fjsb, — ^Eels, salmon, salmon-trout, mackerel, herrings, sprats, and
white-bait^~«ll sorts of salted, pickled, smoked, or potted fish — turtle
oysters, lobsters, crabs, crawfish, prawns, and every kind of shell-fish.

Meat and Animal Products. — ^Ducks, geese, and the flesh of very
young animals generally — meat or game pies and puddings — all pickled,
salted, smoked, or potted meat, forcemeat, and sausages of all descrip-
tions — ^butter not perfectly fresh and good, strong or decayed cheese, hard-
boiled egg^j and honey.

VsaBTABLBs AND RooTs. — Sttccory, Bcorzonere, lettuces of all kinda

iVftteNcresB, mvstard and eress, Boml, ceknry, radishefl, caenmbers, leeiEB,
onions, mushrooms, and truffles.

Condiments. — ^Mustard, pepper, cayenne, ginger, nutmeg, mace, cinna-
mon, cloves, allspice, caraway seeds, saffian, lemon and orange peel, laurel
and bay leaves, bitter almonds, orange flower water, mint, thyme, sage,
parsley, fennel, horseradish, shalots, and indeed every species of spice-
all fish and game sauces, catsup, pickles, and other similar compounds.

SwsBTS AND Fruits. — ^Rich pastry and dumplings in general — all
puddings, creams, preserves, jellies, comfitures, marmalades, all fruits
not perfectly sweet and ripe, and in general all stone fruits, melons,
apples, currants, nuts, walnuts, filberts, and almonds.

Drinks. — ^Wine, spirits and liqueurs of every kind — so also negus,
punch, bishop, and similar compounds — ^porter, ale, beer, spruce or ginger
beer, soda-water, seltzer or other mineral waters, all effervescing draughts
prepared from powders, lemonade or other acid beverages— coffee, green
tea, strong black tea, aromatized chocolate, and butter-milk.

Still it must be repeated, that all tables of diet are general, and
that*\he judicious and attentive praclitioner must prescribe a diet
for each patient. Ther^ are a few suggestions, however, which,
not referring to articles of food only, apply to all who are under-
going the water treatment : —

1. Eat slowly, and chew your food well; otherwise you leave the
Btomach4to do the duty of the teeth as well as its own, besides fiEuling to
mix a sufficient quantity of saliva with the food, which plays an impor-
tant part in digestion.

2. Drink no hot liquids : tepid are the next best : and cold the best of
all : in fact, unless on special occasions, all liquids to be drunk should be
cold.

3. The less you drink of anything at meals the better : not because
tlie liquid dilutes the gastric juice, as some have said, but because it
gives a stimulus to the secretory vessels of the stomach, different from
that of the dry aliment which is the right stimulus, and the consequence
is likely to be the secretion of an improper gastric juice.

4. After eating, let as little excitement as may be proceed from the
brain and spinal cord to the stomach, as it may interfere with digestion.
Therefore^ remain seated, if in the. air, the better ; or if you move, let it
be slowly. For the same reason, avoid all subjects which are a strain
upon the mind : take the thoughts of others in books of easy reading,
rather than exert your own.

6. Let five and a half or six hours intervene between the three meals

of the day : and let the last be a scanty one. Two hours and a half

•hould elapse between the evening meal and bedtime. And the same

llnie, at least, after any meal before any water cure process is pra ctis ed,

17*

870 dut.

flouept foot baths, wliich may be taken as wtm as you please. Sweatinf
may be practised an hoar after a meal.

6. Avoid fruits at all times, except before or at break&st. Dessert of
any kind is inadmissible. It is better to avoid tea altogether, but if it be
taken, it is safer at breakfast than in the evening, the day being before
you : whereas it might make the night wakeful.

7. About two hours after a meal, especially dinner, the stomach being
heated and jaded with digestion, is pleasingly stimulated by a small tum-
bler of very cold water taken in sips, as you would take wine. It gives
a fillip to the muscular coats of the stomach, which then contract, and
expel any air that is disturbing that organ.

Wine and all alcoholic liquors are among the forbiddea things
in the table. For a man who has appetite enough to eat a dinner
of fish, flesh, fowl, and sweets, to add to these stimulants that of
four or five glasses of wine, day afler day, is one of the most pre-
posterous conventionalities that social extravagance ever invented.
And yet to see the solemn regularity with which it is done, one
might fancy it was an act of superlative wisdom, instead of the
stale routine of an absurd and injurious custom. Put it in this
way : either the stomach has appetite, and does not require the
stimulus of alcohol to make it digest, or it has not appetite, and
should not have food put into it to digest. Where, then, is the
necessity for the daily wine-bibbing ? Besides, the stonmch will
only bear a certain amount of stimulation, and if it receives it
from the wine, it is unable to receive it from food also ; so that
the digestion of the latter is materially interfered with by the
former, and the appetite for the stimulus of aliment diminished in
proportion as that of alcohol is applied. But it is an old tale to
repeat the numerous arguments against a foolish custom, for
which there is but one argument — that it w a custom. Of one
thing I am convinced, that it is less injurious to drink a bottle of
wine once a week, and be sick afler it, than to keep up a slow,
smouldering irritation of the stomach, by two glasses of the same
wine taken with stupid precision every day " when the cloth in
removed."

If such is my creed regarding vinous liquors for those who are •
in apparent health, the reasons for avoiding it in those whose
viscera are a focus of irritation, as in chronic disease, will be
potent, and need not be detailed. I would not let the opportunity
pass of expressing my belief in the infinitely superior wisdom of
tbatinenoe from alcoholic liquids under onlinary otrcumstanoes

CLOTHIIfG. 8T1

of health and disease. But were the case one of extreme ezhaitt-
tion from loss of blood, or any other depletory cause, or from ez«
cessiTe hysteria, I should not hesitate to administer any wine or
spirit that was nearest; they are, strictly speaking, medicinal
means of ready application, and, as such, may be wisely em*
ployed in time and place; but healthy men, and men with
chronic disease, do not require medicinal means every day after
dinner. Yet there are men silly enough not only to take a nau*
seous pill of drugs hefore dinner, but this more pleasant, but
equally deleterious draught of physic after dinner !---Strange in-
fatuation !

§ 13. Clothing.

Throughout this work it has been shown that the essential of
all chronic disease is excess of blood in the internal organs, to the
detriment of the circulatory activity of the exterior of the body,
of the skin especially. On this fact the whole treatment de-
scribed in the preceding pages is based, and it renders the cloth-
ing of the body a thing of some importance. It is an aim to
bring to, and fix in the skin, a quantity of blood which shall both
diminish the excess within, and render the skin more able to re-
act upon external agencies, cold, damp, electricity, dsc. Now
this is not to be done by concentration of heat about the skin : the
more you exist in a hot atmosphere, or in a mass of fleecy hosiery,
washed leather and triple coats, the less able does the skin be-
come to re-act upon cold, and the more, therefore, does that cold
tend to drive the blood from the exterior to the interior, and in-
crease the congestion of blood there. It is said that all this
excessive clothing is to keep out the cold : but, in this most un-
steady of climates, at least, the thermometer varies from 6° to
20° in a day, and can it be said that the same amount of cloth-
ing is necessary in both temperatures ? Oh the contrary, the
very excess of covering at the higher temperature, renders the
skin exquisitely sensitive to lower temperature, which comes on,
very frequently, in half an hour ; if the clothing is only enough
at 60°, what is it at 45° ? or if it be just enough at 45®, how ex-
cessive and enfeebling it must be at 60"* ! To keep the skin
in active warmth by a quantity of under clothing, is a most faK
lacious and injurious attempt.

But further, a considerable amount of the wasto of the body it

879 ciOTKUfO.

eflbeted by the skin, and such waste cannot go on widiout free
eontact of the atmospheric air ; contact which is materially pre*
vented by the mass of garments alluded to. The consequence is,
that materials are retained in the circulating blood which ought
to be expended at the skin, and, by their retention, prove a .
source of disorder to the organs in general. For such waste and
elimination the presence of blood in the skin is necessary, as well
as that of air tfpon it : and it is therefore e&sential, on this score
also, to^ blood there.

Lastly, we have to consider the enormous number of nerves,
having their centre in the brain and spinal cord, which are
spread over the skin, and convey sensations thence to the brain.
When the skin is imperfectly supplied with blood, and not re-
active, all changes tell painfully upon these nerves, and in that
manner keep the brain in irritation from that source. Now, a
steady state of the cutaneous nerves cannot be obtained without
ensuring a good snd Jixed supply of blood to the skin.

On every score, then, it is desirable to avoid all clothing which
shall have for view to keep the body in a state of artificial heat.
The skin should be made independent in this respect ; its warmth
should be the result of the chemical changes actively going on in
its actively circulating blood-vessels : and its nerves should be
able to throw off, by the reaction of the circulation, those
sources of irritation which its subjection to them proves so dis-
ordering to the brain and spinal cord. In speaking of the wet-
sheet packing I have endeavored to show how it quiets the brain
by withdrawing the skin from all irritating sources.

From all this it may be inferred, that exposure of the skin to
the free access of air is an essential part of the water cure, and
that therefore the application of much warm under-garments is
not to be practised. But here, again, reservation must be made
regarding the oi^anic capabilities of each patient ; what is excess
of clothing to one may not be so to another ;• and to withdraw tho
flannel jackets of every one who begins the treatment, simply
because he is a water patient, is a blunder of routine which
would materially thin the number of the practitioner's successful
cases. Look at the number of patients who have not blooo
enough to supply the exterior as well as the interior of the frame ;
in such you cannot bring the blood to the surface, until you have
made more of it : the attempt to do it by trusting to the re-action
to be produced on the admission of ur to the bloodless skm, i>

CLOTfilNO. 878

enough to annihilate some of those fi agile individuals. Look
also at the numbers of patients who, although they have blood
enough, have it centred in the chronic irritation of the interior,
and who, besides, have had the skin hermetically sealed by flan-
nel, or silk, or leather, for twenty or thirty years : to strip them
of those coverings simultaneously with the commencement of the
water treatment, is a rashness that would be punished by the ex-
asperation of the internal irritation into active and dangerous in
flammation. Accordingly, I make it a practice in similar cases
not to interfere with the clothing until the appliances of the water
cure have wrought such change in the body's organic state as to
render certain the power of the skin to generate its own sufficient
warmth without the necessity for retaining it by a quantity of
under clothing. This period varies in individuals, and I fre-
quently allow several weeks to pass before attempting a change.
It must always be remembered, that a prolonged feeling of physi-
cal misery, such as the abstraction of warm clothing is apt to
beget, is a state of malaise to the brain, which therefore re-acta
unfavorably on the rest of the body ; and I hold that a patient
who suffers so much in that way, derives as much injury from
the miserable feeling as he can possibly derive good from the
free access of air to the skin. You trmsi Jill the skin before you
give it increased work to do.

Again, when you do begin to withdraw clothing, it is well to
do so piecemeal, especially in such cases as I have indicated. In
a climate like that of England, with its varying barometer and
thermometer, it appears to me more reasonable, if additional
clothing be necessary, to heap it in the shape of outer garments,
which may be donned and doffed with the vicissitudes of the at-
mosphere. In withdrawing the under clothing from delicate pa-
tients, it is often well to substitute some outer covering when the
temperature requires it, at evening or early morning, until the
skin is wholly able to support itself.

When, however, a full-blooded patient presents himself for
treatment, with, it may be, apoplectic fulness of the head, active
irritation of the liver, or some similarly conditioned malady, in
which it is necessary to reduce the whole quantity of blood, as
well as re-distnhute it, I have no hesitation in withdrawing the
flannel clothing at once and entirely. There is then no fear that
the ail will withdraw more heat from the surface than the interior
18*

374 HABITS OF LlFl.

cftn a£S>rd to renew ; and we also advance the process of waste
by the skin, which, in such cases, it is desirable to obtain.

In any case, when once tlie withdrawal of extra clothing is
judiciously effected, it aids materially the progress towards reco-
very ; it is both an evidence of past improvement, and ground
fi)r more and more rapidly-acquired improvement in the future ;
the reasons for which are to be found in the commencement of
this article.

§ 14. Habits of Lifx.

When the nervous system of an individual has been long habit-
uated to the application of certain stimulants, and to the impres-
sion of certain circumstances at certain periods of the day or
hour, and when, with these, his health has gradually deteriorated
and become seriously compromised, the withdrawal of these
periodical stimulants, and the alteration of these periodical cir-
cumstances, become an essential part of a plan of medical treat-
ment which is professedly hygienic. As in the medicinal plan of
treatment, the vulgar and half-educated practitioners alone put
their whole trust in the drugs that are prescribed ; so in the water
treatment, he has a very narrow and vulgar idea of it who thinks
that recovery is effected by the bathings and water drinking
alone, and leaves untouched the habits of the patient. It is not
the mind alone that is the creature of habit, but every sentient
twig of a nerve, and every irritable capillary blood-vessel of every
tissue of the frame. Let a man who has hitherto lain in bed
until 8 A. M., be roused at 6 a. M., it is not his brain only that is
afflicted by the change, but his appetite for breakfast is altered —
he is thirsty, feverish, shivering ; his aptitude for his avocation is
diminished, it is more laborious to him : as a consequence, he
cannot eat his dinner so well, and so on through the day, and per-
haps several days of disagreeable revolution. The altered im-
pression on fhe animal brain has told upon the organic centre at
the stomach, and thence has changed the organic action of the
whole frame. Gradually, however, both animal and organic
systems of nerves accustom themselves to the new order of things,
to the impression of light,^ sound, locomotion, &c.,, bet ween the
hours of 6 and 8 a. m. ; and inasmuch as it is more in accord-
ance with the wishes of Nature, as exhibited in the human body,
that sleep should not be prolonged far into daylight, this new

HABITS OF UPB. 875

arrangement of time Ibr rising eventually proves a wholesome,
although at first an unpleasant one. In this, as in the remedial
treatment of disease, we are obliged to refer to Nature, and make
all our art consist in repeating her dictates and imitating her
staring facts. For, look at the man who lives most closely
according to her promptings ; he goes to bed early, because he
is tired ; he gets up early, because his brain will not sleep any
longer ; he works, because his own hunger and that of others
dependent on him urge him ; he eats, because he is keenly
hungry ; and, last not least, his stomach digests well, and his
brain sleeps soundly, because the cares, scramblings, envy, and
slander of Conventional society are not his. He lives, as nearly
as can be done in a country calling itself civilized, after the
manner of Nature, and he gets his reward in the riches of health.
Now the sufferer from chronic disease who strives to rid himself
of it by the means of the water cure, must condescend more or
less to the neUural habit of life. He must learn to rise early
and to walk or work so as to gain appetite : when this appetite is
acquired he must eat, whether the hour be fashionable or not :
and he must go to bed early from the motive of fatigue alone.
And he wUl do all this in a very short time and find pleasure in
it, and look back on the former habits as on a fevered dream.
Let any one measure the time it took to fall into the bad habits,
and he will find that it takes a much shorter time to fall into the
new and good ones. And this process is expedited by the various
details of the water cure which have been passed in review ;
each one, when properly applied, adding to the alacrity, impres-
sibility and re-active energy of the nervous systems, in which and
by which habits are formed and changed. Allusion has been
already made to the facility with which water patients abandon,
not by degrees, but immediately, the stimulus of wine, without
experiencing any disagreeable want. The same applies to previ-
ous habits of all kinds. They are to the invalid a sort of stimu-
lus, a stimulus which his nervous system expected and responded
to at certain times, and flagged or fidgeted if they were not
applied at those times. The man who has been in the habit of
uming at 7 p. m. with all the forms, strong lights, liveried servants,
two or three courses (though he, perhaps, only eat of one), and
one or many guests, discovers when he is deprived of them, that
all these accompaniments of eating were actual stimulants to hia
nervous system, and that he cannot eat without them ; one course

876 HABITS Of UPE.

tfie fewer, the absence of a guest, or even wearing a morning in.
8te«] of an evening dress, makes all the diflerence in the happl.
ness and appetite of this creatnre of habit. From such wretched
slavery as this, he may be emancipated almost immediately by
the applications of the water cure, and with little or no suffering
to the nervous system. For a few days, he will feel a little
queer, as if " somehow there was something somewhere wanting,"
but the withdrawal of internal irritations, and the stimulation of
water applied to the extremities of his nerves, and conveyed to
their centres, very shortly affords to the latter a sustaining action,
which fully compensates for that which the previous injurious
habits had supplied.

In this manner, the water cure becomes a means of eradicating
unwholesome, and of planting healthful habits in those who sub-
mit themselves to it. Nor is this confined to the body. How
frequently have I seen persons, who were dying of ennui in the
midst of the stimulating gaieties of London, find the day all too
short in this quiet village of Malvern ! I have seen men, whose
jaded and morbid minds could previously take no nutriment save
the garbage of English and French novels, devour the strong meat
of History and Biography with keen and large appetite. And I
constantly remind my patients that the treatment is renovating
their minds as well as bodies, ridding them of the silly wants and
unmeaning necessities which were in part the cause, in part the .
effect, of their physical disorder. " Doubtlessly, much of this is
owing to the removal of that disorder, which takes the weight off
the mental function. But in all chronic disease, there isinore or
less loss of volition, which can only be roused by the necessity
for acquiring some good habit ; therefore, although it were not
directly essential to the body's health to impose certain rules of
life which require exertion of the will, inasmuch as they differ
from previous habits, it is well to insist upon them, for the sake
©f their indirect operation on the nervous system of the body ; I
Him convinced that the mere necessity of undergoing some process
three or four times a day, aids those processes in bringing about
the general result of health. And so far from this derogating
. from the credit due to the water cure, Ithink it rather exhibits the
philosophical character of that treatment which thus acts on mind
and body simultaneously.

With this general view of the operation of habits of life, and of
fSarn fiieceflBity <^ altering tbem, under the rigme of the watorcuw.

2VABITS OP LIFE. 8T3f

ft is unnecessary to enter into extended details : and I shall only
schedule a few of the more important habits to be dropped and to
be adopted.

Early rising should be practised : the sun, the air, the exercise^
and the water drinking are all more beneficial then, than at any
other part of the day. No water patient should be in bed after

6 A. M.

The longer the patient is in bed before midnight the better, due
time being allowed since the last previous meal. Physiological
experiments countenance the old saying that " an hour's sleep
before twelve o'clock is worth two after it."

He should learn to sleep on a hard bed : for excessive heat ex
cites the nerves of the skin, and these convey the excitement to
the brain, which thus becomes dreamy or restless. Six hours'
sleep is enough for excitable persons : phlegmatic and impassible
persons require seven or eight hours. .If you have had either of
these quantities, resist further sleep : the second sleep is seldom
refreshing, and rather disturbing to the brain.

Avoid hot rooms, easy chairs, and lolling on sofas : all these
take from the energy and the volition of the nervous system.

In order to keep the nervous system in wholesome play, let all
the day be accurately divided by baths, packings, walkings,
readings, &c., and let each division be rigidly adhered to and
made a point of honor. In short, make a business of the whole
treatment ; a business with a great aim at the end.

Avoid extensive correspondence by letters, especially with
commiserating friends. It so happens, that most friends express
themselves more anxious about your health than about their own :
'pour faire valoir which anxiety, they usually give you dismal
pictures of your condition, and add warnings about the " dreadful
water cure." Attend to the water cure, since you have under-
taken it, and not to your friends.

Besides alcoholic stimulants, give up the scarcely less delete-
rious stimulus of tobacco, in the shapes of snuffing and smoking.
Both tell injuriously on the nerves of the stomach as well as on
the brain. In the German water cure establishments the patients
smoke ; they also eat saurkrout and heavy pastiy : and, it is said,
they get well. Be it so : but, I repeat, business- worn English-
men are not heavy Germans, and could not safely hear the rovgh
treatment which the indulgence in these hurtful habits obliges in
order to overcome the malady. Nay more, I defy any one ta

878 HABITS OF LIFE.

cure a nerwus disorder or a shattered constitution whilst the
patient is allowed to snuff or smoke tobacco. I would have no
patient who refused to give it up : the. physician should control,
not pander to, his patient.

Other precepts regarding habits are suggested by individual
cases, into which it is too long to enter in a volume. The above
are of general application : and, for the rest, it suffices to state
that all habits which strain the nervous system on the one hand,
or allow it to hecojne torpid from want of employment on the other,
are to be avoided.

A few words on Water Cure Establishments will not inaptly finish
what has preceded. There can be no doubt that certain advantages of
regularity and ready inspection of patients attend the application of the
water treatment in these places. But in order to fulfil their proper aim,
this regularity and inspection should be faithfully carried out. The doc-
tor should be the master of his house, and should firmly resist the wishes
and caprices of all who Would run counter to the stringent rules of water
treatment. There is too much reason to believe that establishments are
rendered attractive to patients by the amusement and the license that are
permitted, and the object of keeping them for a long time by such means
preferred to the legitimate object of cure. They who proceed on such
grounds can scarcely be called professional men, — ^they are hotel keepers.
Thus I know of an instance in which a variety of indigestible articles
were daily served on the breakfast table of an establishment because
some self-important and vulgar patients had the taste to call the simple .
and wholesome fare " shabby." In another instance, a clique of patients
set all wrong by keeping the others waiting for meals, and being great '
people, persuaded the doctor to alter the hours for meals continually, to
the annoyance and detriment of the other inmates. I know of another
instance in which a. patient threatened to quit an establishment if any
veto were placed on his tobacco smoking : the doctor yielded, and the
patient smoked. Had these been princes of the land, I would have
directly sent them to seek other advice. These things going on in water
establishments, will eventually and deservedly bring them into disrepute.
Few cures will be made, wheir the patient is allowed .to regulate his own
treatment and habits : and no one is so ready to publish Ihe failure and
run down the treatment as a patient who has been so mismanaged. Ue
takes his own way, but leaves the responsibility with his doctor : and
this is just, for the doctor is to blame who sacrifices his dignity to his
cupidity. This thing needs much reform. A good rule for the public
would be to suspect all those who advertise and puff their establishments,
who put forth the amusements as baits for the fanciful invalid, and won-
derful cures for the desperately diseased. In this matter there is but at 9

HABITS OF LtFB. . 870

egitimate mode of proceeding : let the physician cure patients, — they will
be his advertisements ; let him publish his experience in a scientific form,
and readers will then believe he knows what disease is ; whereas the ad
captaiidum and exaggi3rated stuff, thrust before the public as a medical
exposition of the power of the water cure, is no more so than are Mor-
rison's propositions about disease, ending in the recommendation of hia
pills, a true account of that condition. Both the newspaper and the book
advertisements are sheer quackery : and water cure establishments will
thus become mere traps.

Again, it appears an arrangement of very doubtful propriety to place
male and female patients in the same establishment. By means of the
bath attendants (and the uneducated toill babble), the infirmities of females
are Uable to become known to everybody with whom they sit at table ;
and I very much question whether this squares with our English notions
of delicacy. Other disagreeables I have known to occur from this
mingling of the sexes in the same house, which induce me to suggest
that the treatment and lodgment of females should be altogether distinct
from that of men. What would a parent or husband say to the presence
of women of doubtful character in the same house with his wife or
daughter ? Yet this has happened. Moreover, a total absence of con-
straint is an essential part of the treatment, and the infirmities of English
pride and stiflhess are too apt to engender it where ladies are introduced:
there happens a great deal of fine dressing and other superfluities of ex-
istence, which were each sex — ^the men certainly — alone, would and
ought to be dispensed with by persons engaged in the attempt to recover
health.

Until these circumstances are altered, water cure establishments are
not very likely to answer the health-seeking aims of invalids, nor to ad-
vance in public and professional favor, the adhiirable system of treatment
which they profess to carry out. Sobriety and propriety are, in this
country, rightly demanded by the thinking in matters of serious impor-
tance ; and what can be more serious than the practical trial of a mode
of remedying disease ? Such trial ought not to-be confided to those who
require puffs, direct and indirect, to draw the unthinking into establish-
ments where the means of lengthening their sojourn is far more a subject
of consideration than their restoration to health. In due time, this sys-
tem of hotel keeping will fail with the public, and then all the benefit
which is unquestionably derivable from ttfatment in a water cure estab-
lishment will have an opportunity of being obtained, the physician com-
oromising none of his professional dignity, and the patient being boond*
a> the single object of regaining health.

APPEND II

I.

ANSWERS TO OBJECTIONS URGED AGAINST THE WATER
TREATMENT OP CHRONIC DISEASE.

[The tdiole of this Appendix is from my pen, but was published by Dr.
Wilson and myself in a work entitled ** The Dangers of the Water
Cure examined," &c.; a few verbal alterations only being made.]

The accusations advanced against the water treatment are first stated
at the head of each section, and then answered. As most of them, have
been made by medical practitioners, generally of the apothecary kind, it
is well to mark, that the chief refutation of them is drawn from anthmv
who deservedly stand high in the estimation of the medical world,
whether of the drug or water persuasion— authors whom mere apoth«
caries never read.

1. The Water Treatment thiks the Blood.

Such a^ efl^t of water drinkmg is not -mentioned by any of the au-
thors who have made the diseased conditions of the blood their study.
Let the lyritingB of Hoffmanh,^ Frjerd,^ Schwehcke,^ BuxcaiiVB,*

> De Sanguine et ejus Observatione. 4to. 1660.

t JE4mmen9lQgi»i Opera ompia. London, fol. 1733.

* Hematologia, sive Sanguinis Historia. 4to. 1743.

4 Dt nimia Sanguis Fluiditate et Morbis inde Oriu|MM«« ^* VMf

38S AFPBNDIX.

HiWBQir,* Hbt,* Grctrsk,* Thackrah,* Belhommb,' Schttltz* Bsi^
hOQMB.U' Strvbns,* and a host of others be consulted, and we defy the
reader to find in any one of them the thinning of the blood attributed to
dilution with water. These writers are niost minute in their enumera-
tion of the causes of the blood's deterioration, and some of them give
precise accounts of their experiments on this head, but nowhere do we
find water mentioned as an impoverisher of the vital fluid. On the other
hand we do find, from the experiments and observations of SeftwE5CKS>
F&iBin>, OouRTSN, PiTCAiRNE, and Thackrah, that the employment of
those medicinal agents, the fixed and volatile alkalies (including the car-
bonates of potash, soda,' and ammonia, sal volatile, &c.) has a particu-
lar efiect ib attenuating' the vital fiuid, breaking up its coagulating
power, and thus inducing a diminished vital cohesion of the various tex-
tores of the body formed from it Further, we find from the experiments
of Lb Cant;, ''that another very favorite remedy of drug medication has
the power of singularly " thinning" the blood, by the removal of the
rich red globules which give it color. He found that a first bleeding
furnished in 1000 parts of blood 792.897 of water, 70.210 of albumen,
9.163 soluble salts and animal extractive matters, and 127.73 of glob-
ules. But after a third bleeding, a few days afterwards, in the same
patient (a female), the proportions were 834.063* of water, 71.111 of
albumen, 7.329 of soluble salts and extractive matters, and 87.510 of
globules,— showing a diminution of 31 per cent, in the course of a few
days,*of that ingredient of the blood which chiefly constitutes its rich-
ness!

Again, what say medical auth6rs of mercury — another favorite medi-
. cine and '* sheet anchor" — and its agency on the blood ? Dietrich teHs
us, that soon after salivation has been established, the blood exhibits an
inflammatory crust ; at a later period its color deepens, and its coTtjngO"
hUxty is diminished ; the proportion of clot, and therefore of fibrin, to serum
(or toatery part) becomes smaller; the formaiion of albumen and mucus
9inks to tiuu of serum : the whole crgarnc formation of the patient is less
eonststeni and cchesive,^^ Another writer of weight says, in' the most

1 Experimental Inquiry into the Properties of the Blood. 8vo. 1771.

• Observations on the Blood. London, 1799.
» De Pathologia Sanguinis. Jena, 1791.

*' < On the Properties of the Blood. 8vo. 1819.

• Observations sur le Sang, 4to. Paris, 1823

• Meckel's Archiv. f iir Anatomie und Physiologie, 1826, No. iv.
' Annali Universali di Medicina. April, 1827.

s Paper read to the London College of Physicians, in May, 1830.

• Httzham says {Essay on Fevers, pp. 48 and, 308), that adkalies indues
a scorbutic cachexy ; that is, a dissolution of the solid parts of the body.

10 Nouvelles R^cherches sur le Sang, in Journal de Pharmaeie Sep*
tember and October, 1831
^i Op. supra cit» 80.

TBX5 BLOOD. 888

naive maimer imaginable : " A full plethoric wcman, of a parple red com-
plexion, consulted me for hsmorrhage from the stomach, depending on
engorgement, without organic disease. / gave her' mercury, and in six
weeks blanched her as white as a ZtZy."^ From all which it would appear
that there are shorter and surer modes of ^ thinning the blood " than by
water drinking.

There is a diseased state denominated Amcmia or Bloodlessness, in
which the blood is deficient both in quantity and quality : a fiimiliar and
too common instance of wWch is the green sickness of girls. Now, in all
the medical works on this disease, allusion is never once made to water
drinking as a known cause, — not even to the possibility of its being a
cause of it One would imagine that, in writing on so flagrant an ex-
ample of ** thin blood," this would scarcely be passed over were it so
(Certain a cause as it is now said to be, of the disease in question. Yet '
for anything of the kind, it is vain to search the pages of Becker,^ Al-
bert,' Janson,^ Chomel,^ Roche," or Combe,^ all of them authors of re-
cognized ability and consequence. On the other hand, bad, moist atr,
poor and insiifflcient food, exclusion from light, residence in hot rooms,
. and excessive secretions and evacuations (purgatives and diuretics, to wit),
are recited as the most common causes of the impoverished state of the
blood alluded to. To these are to be added as cause any disease of the
digestive organs which, interfering with the proper digestion of the food,
leluls to the formation of blood deprived of the red globules. Nay, Dr.
Copland says that general bloodlessness will not take place without some
such disease. His words are :

'' It is probable that general anaemia will not take place, unless con'
sectUively of remarkable torpor of the vital influence, or of some morbid
condition of one or more of the organs which contribute to the formation
of blood. Where the digestive powers and the functions of the liver are
weakened, ansmia is not infrequent. I am disposed to view the liver
as being equally, if not more concerned in this function of blood-making
than the lungs."

And again he says :

" Deficiency of blood, as refects both its diminished quantity and its
poor quality, or the defect of red globules, is often associated with viscc
ral disease, of which it is generally the consequence."* .

1 Dr. Farre, as quoted in Ferguson* s Essays on the Diseases of Womtn^
Part I., p. 216;
' Diss. Resol. Casus Pract. Anaemis. Leyden, 1663.
3 Dissertatio de Anaemia, 732.

* De Morb. ex Defectu Liquidi Vitalis, 1748.

* Dictionnaire de Med. et Chirurg. Pract, torn. ii. Art. Animim
' Dictionn. de Med., lorn. ii. Art Enimie.

' Transact of Med. and Chirurg. Society of Edinburgh, toL i

* Dictionary of Practical Medicine, p. 174. sect 43-44.

884 APPENDIX.

Fwtlier on he lays down, as '^ a grand pathological inferenee»** the
following :

^ The inierraptiori or obstruction of any important secreting or elimi-
nating function, if not compensated by the increased or modified action
of some other organs, vitiates the blood more or less ; and if such vitiation
be not soon removed, by the restoration of the function primarily affected^
or by the increased exercise of an analogous function, more important
changes are produced in the blood, if the energies of life are insufficient
to expel the cause of disturbance, to oppose the progress of. change, and
to excite actions of a salutary tendency.'*'

Taking this sentence as a text, and having an eye to those which pre
cede it, we shall take the liberty of preaching a little sound physiology
to those who talk about ** the thinning of the blood."
- Of the patients who resort to Malvern for the treatment by water, aii,
exercise, and diet, seven out of ten labor under the interruption or obstruc-
tion of more or fewer of the organs which minister to the digestion of
food ; and the periods of their ailments date variously from two to twenty
yean previously. During these Jong years they have run the gauntle
of all the means of drug medication, and, however painful it may be tc
repeat the fact, they all tell iis that they are worse than when they began
60 to run. During these years, too, the obstructed salivary glands, the
obstructed liver, the obstructed bowels and kidneys, the interrupted o
vitiated secretion of gastric juice, and the general disorder of the
digestive mucous membrane, and of the nerves supplpng it, have, ill
greater or smaller array, and therefore in varied degree, maintained a
diseased digestion of the food, whence a vitiated blood comes thus to be
formed. Besides tliis, more or fewer of the obstructed organs ceasing
to pour out their secretions and excretions, the elements of these are
retained in the circulating blood, which they further vitiate. And to this
the want of proper elimination of matters from the skin (to which^ in the
great mq/ority (f instances, no attention whatever has been paid), and, las
not least, the absorption iiito the blood of the infinite variety of poison
ous medicines that have been tried in the years of suffering ; — and some
idea may be formed of the sort of blood w^ch is circulating in the bodies
of patients so circumstanced, and the character of the solids deposited
from that blood. In fieust, the leaden or parchment complexion, the yellow
eye, the dry or waxy lip, the foul tongue, fetid breath, diseased secretions
and excretions generally, the pufily, morbid fat, and flabby muscles, aL
testify to the vitiated condition of the vital fluid. Now supposing that
the water prescribed to be drunk by these patients had only for final aim
to *^ thin" the blood, we are at a loss to behold any great mischief in
diluting such a mass of semi-poisonous liquid. But when we find the
skin becoming florid, the eye clear, the lip red and plump, the tongue
clean and moist, the breath sweet, the bowels and kidneys aflfording

* Op. cit, p^ 190, sMt. 124.

THIN BLOOD. 985

wealthier excretions, and the moscles hardening, under the operation of
water drinking, it is reasonable to suppose that it does someUiing more
or something else than " thin" the blood ; particularly when the increased
consumption of the oxygen of the atmosphere during the exercise of
which they take abundantly, is given into the account. And that changes
such as these occur in the process of our treatment at this place may be
seen by any one who pleases to ask patients for a comparative statement
of their previous and present condition. To account for this, a few
physiological data may be given.

The learned Liebig informs us that ** the two first conditions of animal
life are nutritious matters and oxygen introduced into the system,"^ and
that in the varied transformations e^cted by the varied combinations of
the ek mc'nts of food and oxygen, the phenomena of animal life consist*
These iransformations are all effected in the blood, derived as it is from
the food and the oxygen of the atmosphere.3 For the due performance
of the vital functions— i. e., transformations — ^the presence of vxAsr in
the blood is (ibsoltUely necessary.* This is especially shown by the pro-
portion of water in healthy blood, which, according to Lavoisier and
Seguin, as quoted by Liebig,® is eighty per cent,, as well as by the
enormous proportion which it bears in the chemical composition of all
the secretions. Hence it is essential that cUl the food be so changed in
the stomach as to become equally soluble in water, and thus be capable
of entering into the circulation.* Whilst from the food thus changed
two elements, carbon and hydrogen, are derived, these are carried
round with the blood and meat with oxygen introduced at the lungs
and through the skin ; and, combining with it in those places, car*
bonic acid gas and the vapor of water are formed and expelled from
the body, one part of the oxygen mingling with the carbon to form the
gas, and the other part of it with the hydrogen to form the water.? Now
if sufficient supply of carbon and hydrogen be not taken in the shape of -
nutriment and drink to meet the supply of oxygen afforded by the
atmosphere, death by starvation or chronic disease takes place. Of this
LiEBiG says :8

" The time which it requires to cause death by starvation depends on
the amount of fat in the body, on the degree of exercise, as in labor and
exertion of any kind, on the temperature of the air, and finally, on the
presence or absence of water. Through the skin and lungs there escapes
a certain quantity of water, and as the presence of toater is essential to
rhe crmtintuince of- th^ vital motions, its dissipation hastens death. Cases
have occurred in which a full supply of water being accessible to the

> Organic Chemistry in its Applications to Physiology and Pathology, p. 12
«IbiA.,.p. 9. « Ibid., p. 8.

* Ibid., pp 3, 43. 136, 140, 141, 142, 148, 153 to 159, 180, 181.

• Ibid., p. 13. « Liebig, pp. 108, 109.
'Ibid., p. 13. « Ibid., p. 27

18

S86 AFPSNDIX.

■uflbier, death has sot oceuned until after the lapeeof twenty days.* Ik
one case life was sustained in this way for a period of sixty days.'*

This certainly does not look as if the water had impoverished the blood.
But further : according to the same authority this same ^ thinning "
water is absolutely necessary in chronic disease, at least the want of it is
a chief cause of death in them. Liebio tells us in the very next para«
graph —

" In all chronic diseases death is produced by the same cause as in
starvation — ^viz., the chemical action of the atmosphere. When those
substances are wanting whose function in the organism is to support
the process of respiration; when the diseased organs are incapable
of performing their proper function of producing these substances ; when
they have lost the power of transforming the food (in which water so
materially aids) into that shape in which it may, by entering into com-
bination with the oxygen of the air, protect the system from* its influence,
then the substance of the organs themselves, the fat of the body, the sub-
stance of the muscles, the nerves and the brain are unavoidably consumed."

Prom ail this we learn that the presence of water in the blood tends to
quicken those transformations of the blood in which the act of life essen-
tially consists. Moreover we learn that if, whilst the elements carbon
and hydrogen are being freely and rapidly formed from the aliment, the
body is placed in such a condition as to obtain a good amount of oxygen
to combine with them, a vivid degree of vitality is imparted to the entire
organism, and the strides of chronic disease and of death are arrested.

Now these are precisely the states brought about by the water treat-
ment. The very first of its effects is to produce appetite ; many pa-
tients being actually ashamed of the quantity they eat, or are in-
clined to eat. Whilst carbon and hydrogen are thus largely formed
by food, a proportionate quantity of oxygen is made to be taken in by
. means of exercise ; for as the number of respirations regulates the quan-
tity of oxygen inspired, and as these are more frequent in exercise, the
result is the presence of a large quantity of that vivifying gas to meet
and combine with the large quantity of carbon and hydrogen supplied
from the aliment, that is, the solid food and water. The results of this
more vivid vital state are to remove the obstructions and interruptions oC
the organs above mentioned, and thus to restore secretions ; to produce
more rapid transmutations, and thus to renew the previously vitiated
blood ; and, by the gradual substitution of healthier blood, to cause a de-
position of healthier solids. And we submit that none of these results
give the slightest indication of impoverished blood.

We have entered into these physiological explanations in order to
show the laical reader how much and how little he should rely on the
loose off-hand assertions of his professional friend, from whom some ra*
tionale of the so-called " thinning of the blood " may reasonably be ex-
pected. Be that fluid thinned or not, the water cure has the results above
mention<id, and we might content ourselves by referring* to th« aigiMi ill

TBIll BLOOD. 887

Che complexion alone, of those who have tried it, of redder and richer
blood circulatingr where for years it had ceaaed to circulate, being con-
gested on some internal organs, there causing obstruction of function.
To hear the solemn trash vented on this matter of the blood, one might
imagine that water were a thing abhorrent to the human organism, and
to be drunk only when all drugs had failed, or not even then. Where-
as we are told by a high physiological authority that '* water consti-
tutes four-fiilhs of the weight of the animal tissues, and without it
they are wholly insusceptible of vitality."^ And Liebio states^ *' that
6361 parts of anhydrous fibrine (i. e. fibrine deprived of all water), are
united with 30,000 parts of water in .muscular fibre or in blood." With
these two data the kical reader will be the less astonished to hear, from
good authority also; that the water actually assists in the formation of .
the sdid parts of the body. Count Rumford announced this long ago,*
and Pereira holds the same opinion. Rostan likewise remarks that
^ water is the principal source of vegetation, itself the source of all ani-
mal life, that it acts on the animal both by its admixture with atmo-
spheric air (as in respiration and by the skin), and by its presence in the
digestive canal, where it acts directly by aiding in the renovation and
growth of the individuaV^l We daily behold the muscles of patients
acquiring increased volume and firmness under the operation of the
water cure, and the exercise they are enabled to take soon after com-
mencing it tells of anything rather than the helplessness that attends
impoverished blood and attenuated solids. The first surgeon in Europe,
DiEFFENBACH, of Berlin, recently stated that, in amputating limbs after
accidents, he invariably found the severed muscles of those who had
been treated by water, and were habitual water drinkers, of a much more
vivid red color, of greater compactness, and more contractile than in
any other individuals.

But the whole assertion regarding thin blood proceeds on* grounds that
betray intense ignorance both of physiology and of the water cure. It
supposes that the whole water imbibed enters into and remains in the
circulating blood qtuxsi water, that no chemical transformation of it
takes place in the body at all ; this is ignorance of physiology. And it
supposes that aU who are treated by water are told to drink the same,
and that a large quantity of water, without discrimination of the in-
dividual cases of disease presented ; — ^this is ignorance of the water
cure. So between the horns of this compound ignorance, and of wilful
misrepresentation, we leave the declaimers about the " thinning of the
Wood."

' MiiuJCR, Elements of Physiology, p. 7.

* Organic Chemistry in its Application to Agriculture and Physiology.
"Essays, vol. i.,p. 194, 5th edition, 1800.

* Elements of Materia Medica and Therapeutics, vol. i., p. 69

* Coors Elementaire d'Hygidne, torn, i., p. 228.

868 APPENDIX.

3. ** Thx Watsk Trbatmeht exhausts the Ahimal Heat.**

From this very absurd proposition, we might, as in the former in*
stance, appeal to the patients who have been treated at Malvern. The
great majority of them arrive here with the skin so exquisitely alive to
any the smallest decrease of temperature, that, in some cases, we found
fires blazing in their rooms in the month of August. The same sensi-
tiveness is testified, and indeed maintained, by the accumulation of flan-
nel, silk, and soft leather, in which they are clothed on their arrival
here. How is this to be accounted for 7 And how is it to be explained
that, after a longer or shorter trial of the water cure, these same patients
go out into all weathers, in early morning and at night, throw aside
their multiplied under clothing, and defy rain and snpw, and keen frost ?
We propose, in answer, to turn to the pages of an authority which our
medical brethren will scarcely gainsay.

Referring again to the doctrine of Liebig, given when addressing our-
selves to the question of " thin blood," and which makes the vital ac-
tivity consist in the transformation of the elements of the food into the
blood, this again into the solids and secretions, and these again into blood,
containing carbon and hydrogen, to be consumed by the oxygen of the
atmosphere ; — we find in the work of the same learned author, that the
source of animal heat is attributed to the same process of consumption of
the carbon and hydrogen of the food by the oxygen of the atmosphere.
He says,*

*' The mutual action between the elements of the food and the oxy-
gen, conveyed by the circulation of the blood to any part of the body, is
the source of animal heat."

This being established, let us next ask by what means this heat is
maintained under varying circumstances? And let the same author
answer :

" In the animal body the food is the fuel ; with a proper supply of oxy-
gen we obtain the heat given during its oxidation or combustion. In
winter, when we take exercise in a cold atmosphere, and when conse-
quently the amount of inspired oxygen increases, the necessity for food
containing carbon and hydrogen increases in the same ratio ; and by
gratifying the appetite thus excited, we obtain the most efficient protection
against the most piercing cold, A starving man is soon frozen to death ;
and every one knows that the animals of prey in the arctic regions far
exceed in voracity those otthe torrid zone.

" In cold and temperate climates, the air, which is incessantly striving
to consume the body, urges man to laborious e^rts, in order .to furnish
the means of resistance to its action, while in hot climates, the necessity
of labor to provide food is far less urgent.

** Our clothing is merely an equivalent for a certain amount of food. The
more warmly we are clad, the less urgent becomes the appetite for food*

' Organic Chemistry in its Applications to Physiology and Pathology, p. n

HEAT OF THE BODY. 9M

because the loes of heat by cooling, and consequently the amount of heal
to be supplied by the food, is diminished.

** If we were to go naked, like certain savage tribes, or if in hunting or
fishing we were exposed to the same degree of cold as the Samoyedes,
we should be able with ease to consume ten pounds of flesh, and perhaps
a dozen of tallow candles into the bargain, daily, as wam^y-clad tra-
vellers have related with astonishment of these people.

" According to the preceding expositions, the quantity of food is regu-
lated by the number of respirations, by the temperature of the air, and
by the amount of heat given off to the surrounding media."i

To apply this. Our " warmly-clad" patients come to Malvern without
appetite, and afraid of the slightest cold air. We subject them to the
action of cold air, by causing them in due time to throw off their warm
clothing : we further subject them to the action of cold water applied to
the skin in the shape of baths ; — and, lo ! in a few days they get an ap«
petite ! How this comes to pass, let the above quoted paragraphs say.
We defy the whole medical fhitemity to disprove lie truths they contain.

Well, then ; behold the patient with an appetite, — ^in other words, with
the capability of supplying carbon and hydrogen abundantly to the
blood ; behold him taking exercise, and thus augmenting the number of
his respirations, in other words, supplying oxygen to meet the^ carbon
and hydrogen which his appetite aflbrds ; behold, in consequence of the
mutual action of these elements, an increased rapidity of supply and
waste, of vital activity and chenycal combustion, — asd therefore an

AUGMENtED AMOUNT OF ANIMAL HEAT.

But it may be said that all this applies only to the operation of exter-
nal cold, and BfBards no argument against the assertion that the drink'
ing of cold water abstracts the animal heat. This is true, as far as
the mere withdrawal of heat is concerned : but the ultimate e^ct on the
increase of food taken, and of oxygen consumed, and therefore of animal
heat generated, still holds. Hear LrEBia again :

" The cooling of the body, by whatever cause it may be produced, in-
creases the amount of food necessary. The mere exposure to the open
air, in a carriage, or on the deck of a ship, by increasing radiation or vapor-
ization, increases the loss of heat &nd compels us to eat more than usual.
The same is true of those who are accustomed to drink large quantities of
cold toater, which is given off at temperature of the body, QS'S.® It inr
creases the appetite, and persons of toeak constitution Jlnd it necessary, by
continued exercise, to supply to the system the oxygen required to restore the
\eai abstracted by the cold water,**^

What can be more confirmatory of the philosophical principles on
which the water cure proceeds than this proposition of so justly dis- .
tinguished a writer ? And every word of it is practically proved on
these Malvern hills, where, by exercise in the open air, after the various
processes of the treatment and drinking water, Uie capabilities of taking

> Op. «it , p. 21. « Op. «it., p. 24.

•00 APFBNDIX.

f»d and of reristing cold are gained for those who heretofine poawwrf
neither.

To hear the absnrdities tittered on this subject, one might be led to
imagine that the evolation of animal heat was a process carried on to a
very scanty degree in the human body, and that the quantity of it gene-
rated in twenty-four hours in an adult man, would be utterly expended
on the water of the shallow and hip-baths taken in that period. The
non-professional reader will, therefore, be surprised at ^e following
■tatement, made on accurate experiments undertaken by natural philoso-
phers of the highest character.

" According to the experiments of Desfbetz, 1 oz. of carbon evolves,
during its combustion, as much heat as would raise the temperature of
106 oz. of water at 32*> (the freezing point) to 161^, that is, by 136 de-
grees ; in all, therefore, 106 times 136^= 14207 degrees of heat Con-
sequently, the 13'9 oz. of carbon, which are daily converted into carbonic
acid in the body of an adult, evolve 13*9 >4l4207<'=10747'3 degrees of
heat This amount of heat is sufficient to raise the temperature of 1 oz.
of water by that number of degrees, or from 32° to 1 97509-3* ; or to cause
136-8 lbs of water at 32* to boil : or to heat 370 lbs. of water to 98*6*
(the temperature of the human body) ; or to convert into vapor 24 lbs.
of water, at 98*6^ ! If we now assume that the quantity of water vapor-
ized through the skin and lungs in twenty-four hours amounts to 48 oz.
(3 lbs.), then there will remain, after deducting the necessary amount
of heat, 146380*4 degrees of heat, which are dissipated by radiation, by
heating the expired air, and in the excrementitious matters."'.

Why here is heat generated by one individual in twenty-four hours,
almost sufficient to boil the water in which he bathes, and that which he
drinks ! And yet persons calling themselves educated medical practi-
tioners and physiologists, talk about the water cure " exhausting the
animal heat !"

Should, however, the reader desire to learn the mdst effectual way of
destroying the power of generating animal heat, let him pursue the ]dan
which so many shivering patients who come to Malvern have followed.
Let him drink spirits and wine, eat condiments, swallow purgatives, and
especially mercurials, take '< a course of iodine," and, as an occasional
interlude, lose a Uttle blood ; and we stake our reputation that he will
shiver to his heart's content, and find himself many degrees lower in the
scale of Fahrenheit than cold water, cool air, e^rly rising, and exercise
can possibly place him.

' LiEBio. Op. cit., p. 34. The quantity of carbon (13*9 oz.) stated is
calculated, from the analysis of all the aliment taken in twenty-four hours,
by a company of the body-guard of the Grand Duke of Hesse Darmstadt,
consisting of eight hundred and fifty-fiTe men. It was composed of beef,
pork, potatoes, peas, beans, lentils, sour krout, grpen vegetable, bread in
soup, salt, onions, leelcs, fat, and vinegar : in all containing, after analysis,
for Mch man, 13*9 oz. of carbon daily.

TONE OF THE STOMACH. 391

B. "The Watee Cube destroys the Tore of the Stomach."

Is it the cold of the water imbibed which destroys tlie tone ? How then
somes it to be given, by universal consent, in fevers, where the tone of
the stomach is already low enough? Is there a physician in these
days bold enough to assert that warm water destroys the tone of the
stomach less than cold 7 Where is the tone of the stomach in
gout ? Yet from Heyden> downwards, coU water is the recog-
nized beverage for gouty persons. Dr. Pereira tells us that the
drinking cold water "facilitates the recovery of epilepi^y, hysteria,
and fainting, and alleviates gastric pain and spasm ;^' and further, that
" large draughts of cold water have sometimes caused the expulsion of
intestinal worms ;" —effects which, we submit, it could not have producedi
had the cold water had the result of " destroying the tone of the stomach."
He also states, that " ice-cold water, or even ice, when swallowed, causes
contraction (certainly indicative of increased tone) of the gastric blood-
vessels, and thereby checks or stops sanguineous exhalation (certainly
.indicative of decreased tone) from the mucous membrane of the stomach :"
that on taking ice, or ice-cold water, "temporary contraction of the
alimentary canal is produced : that a feeling of warmth follows that of
cold in the pit of the stomach, and quickly extends over the whole body,
(so it does not exhaust the animal heat !) accelerating somewhat the
circulation and promoting the secretions of the alimentary canal, of the
kidneys, and the skin."^ Finally, the same elaborate writer says of
cold water, that " it is a vital stimulus, and is more essential to our
existence than aliment.".^ In all which we are at a loss for any signs of
destruction of the stomach's tone.

Is it by dilution of the gastric juice that cold water impairs the tone
of the stomach ? The last cited author seems to think the affirmative,
when he says, " Water serves at least two important purposes in the
animal economy j it repairs the loss of the aqueous parts of the blood,
caused by the action of the secreting and exhaling organs ; and it is a
solvent of various alimentary substances, and therefore assists the
stomach in the act of digestion, though, tf taken in very large quantities,
it may have an opposite effect, by diluting the gastric juice,^^* Unfortu-
nately for the trutii of this proviso, with reference to the water cure, no
medical man practising it as he ought to do, would prescribe cold water to
be drunk " in very large quantities" at a meal, nor for two hours at least
afterwards ; on the contrary, not more than a small tumbler should be
taken whilst eating. And, as regards copious drinking of it when
the stomach is empty, — in the early morning, for instance^ when it is
especially recommendable, — ^we have the best authority for saying, that

^ Arthritifugum Magnum ; a Physical Discourse on the Wonderful Virtues
of Cold Water London, 1724.

> Elements of Materia M^dica and Therapeutics^ vol. i. page 33.
Published in 1842.

• Op. eit., p. S4. • Ibv« pp. 68. 69.

898 AFTBNDIX.

if nutriiitnu aliment is applied to its cavity,^ and therefore no dilution of
k can take place, and no cQminntion of tone thence be caosed.

Lastly, is it by its balk that cold water impairs the tone of the stomach ?
If the six or eight tumblers of water, imbibed by a person before break-
ftst, aU remained in the stomach unabsorbed, its bulk would probacy ir-
ritate the stomach to the point of vomiting, and the exhaustion of the
stomach subsequent on such eflS>rt, frequently repeated, might induce
atony of its coats, as repeated vomiting from any cause tends to do.
But this cannot take place in the course of the water cure ; iirst, because
its practice does not countenance the taking of more than one tumbler at
a time, and insists on exercise in the intervals between each ; and, se-
condly, because it is well ascertained that the absorption of water by the
stomach is a surprisingly rapid process, ** all drinks," according to Dr.
BEAtTMONT, ** being immediately alDSorbed, none remaining on the stomach
ten minutes after being swallowed*'** We heard a medical practitioner,
who had seen a case similar to that of St Martin (a perforation from
the Bur£Bu:e of the belly into the cavity of the stomach), say, a short time
ago, '* that the sucking up of water by the coats of the stomach, resem-
bled the manner in which rain is taken up by the burning sands of %^
desert." And all physiological investigation proves that the empty sto-
mach has amazing vivacity of function in this particular. For the rest,
we are contented to refer again to the words of Liebig (at page 68),
that <* large quantities of cold water increase the appetite ;" and to the
daily exhibition of this fact in our patients. And we therefore contend
that that which augments ike appetite cf the stoTnach cannot be destructive
ef its tone. It were well for mankind, had they no more ef^tual way
of destroying the tone of the stomach than by drinking water !

4. "The Watee Cuke peoduces Deopsy;" and,
6. " The Watee Cxjee injuees the Bjdnets by nroucra© exces-
sive Action of them."

We place these opinions in juxtarposition, in order that the reader
may form some idea of the anilities which mere prejudice is capable of
uttering. Here are two states : one supposing a want of action in the
kidneys, the other an excess of action in them. How in the name of
logic can both acknowledge an identical cause ? Yet both are gravely
asserted to arise from drinking water ! Let us endeavor to place those
who hold by the retention of the water in the body, and those who assert
its too rapid exit therefrom, at ease on both points.

I Case of Alexis St. Martin, in Dr. Beaumont's ** Experimenis and O^'
Bervationson the Oastrie Juice and the Physiology of Digestiont^ p. 96
Gdinbuigh, 1838.

■ Op. cit, p. 99.

DEOfST. 898

• Two kinds of dropsy are described by all medical writers on the sub-
ject : that which arises from inflammatory, or some analogous action in
the seat of the dropsical coUection (the chest, belly, or the cells underneath
the skin) : and that which ensues upon obstruction of the circulation by
reason of disease of the heart, the lungs, the liver, the spleen, or some of
the large veins of the body. Of late years, it has been shown by Bright,^
Chaistison,' Gbeoory,' Osborne,* Martin Solon,^ and Rayer,< to be
connected in some instances with a particular organic disease of the kid-
ney : of which we shall by and by say more. With whatever condition,
however, of the dropsical part the disease may be allied, one fact is invari-
able in the history of dropsy, viz. the diminished action of the kidneys,
and therefore the diminished quantity of fluid evacuated by them ; a di-
minution of which patients in the water cure, we venture to say, never
yet complained. Referring to the dropsy connected with local inflamma-
tion, we find the greater number of authors attributing it to suppression
of the perspiration, or of any of the natural secretions and discharges,
and to the driving in of any eruption. Referring also to the dropsy
dependent on disease of the heart, lungs, liver, &c., we find all medical
writers explaining this by the stoppage of the circulation in consequence
of obstructions in those organs, and the subsequent congestion of blood
and efiiision of its watery parts in some of the cavities. But in all the
treatises on this disease, from Hippocrates^ downwards, the medical or
the non-professional reader will seek in vain for the use, or even the abuse
of water as a cause. It is true that many of the older writers tortured
their dropsical patients (who are always thirsty) by forbidding liquids ;
but every practitioner is now well aware of the absurdity, and even in-
jury of the restriction, which, however, still obtains as correct with very
many of the laity. Upon this erroneous and injurious notion, the opi-
nion that " water drinking causes dropsy " is calculated to play, as they
who emit it well know. But would any educated practitioner venture,
in a case of dropsy, to act upon such a notion, and debar his patient
from as much water as he chose to drink ? We opine ^that he would be
pointed at as an ignoramus and scouted by his brethren for his utter
want of scientific and practical knowledge. If, then, the free taking of
water be not conducive to the increase of dropsical disease, when the
kidneys and skin are carrying off liquids imperfectly^ how should it pro-
duce dropsy when both the kidneys and skin are acting freely— n&j, carry*

» Reports of Medical Cases. London, 1827.

• On Dropsy from Disease of the Kidney. Edin. Med. and Surg Jour-
nal, vol. xxxii., p. 262. 1829.

8 Edinburgh Med. and Surg. Journal, vol. xxxvi., p. 315. 1831.

• On Dropsies, &c &c. London, 1835.

• De PAlbuminurie. Paris, 1838.

• Traite des Maladies des Reins, &c. Paris, 1839-40.
' Aphorism. 3 to 7 ; at Opera, passim.

18*

M4 AmsMmx.

ittf off mors tfaan the uBud quantity of fluids by virtae of tiie exerdae
enjoiiied in the water core ? The propoeition carriea abanrdity on the
free of it

But we further maintain, that in those cases wherein the dropsy is
attributable to obbtraction of circulation in the liver, spleen, or sweet-
bread, the copious drinking of water, aided by the other appUcations of
the water cure, is a powerful agent in the etire of dropsy. If there be a
diseased state which our plan of treatment is more especially calculated
to remove, it is to be found in that obstruction of the liver and other solid
organs of digestion, which, in the majority of instances, gives rise to
dropsy. Of the removal of such obstruction, we have already given the
rationale. And inasmuch as in the case before us, the dropsy is attacked
in its source, and the torpid liver, &c., put into action, we have good
reason to prefer the water treatment before that which only aims at
stimalating the kidneys by all kinds of irritating diuretics, leaving the
original seat of the mischief in the liver to take its chance, or, possibly,
to be deteriorated by those very diuretics (calomel, colchicum, squill, and
so forth) applied to the stomach.

This leads us to the consideration of that species of dropsy which is
connected with the organic disorder of the kidneys denominated " granu-
lar disease," and described by Bright, Christison, and others. When
it is alleged that the v^rater cure causes disease of the kidneys, we are
not aware that particular allusion has been made to this '* granular" con-
dition ; — very probably, they who pronounce the opinion never heard of
such a condition. But as medical writers have never yet spoken of any
other state of the kidneys as prodactive of dropsy, we conclude that the
disease in question is the one intended to be seen through the haze of
prejudiced ignorance which surrounds this opinion. If the authors who
have published on this subject are to be relied on (and they comprise the
most respectable names in medicine), the causes of the complaint in
question are, 1, suppressed action of the skin ; 2, drinking of spirituous
liquors.; 3, the employment of stimulant diuretics ; and 4, courses of
mercury. But none of them allade in any way to copious dilution with
water as a cause.

With regard to the suppressed action of the skin, it can scarcely obtain
in the water cure, where the increased action of that important sur&ce
forms a prominent feature, and wherein sweating is a principal agent. On
this last, indeed, Dr. Osborne places his greatest reliance in the cure of
dropsy :i asserting that '^ sweating being accomplished, the disease, if free
from complications, never fails to be removed."^

Neither do spirituous liquors figure in the water cure, which may
tlierefore, quoad hoc, be declared guiltless of causing renal dropsy. Why
do not our medical brethren, who utter warnings about waier and dropsy,
raise their voices on the subject of spirits and dropsy 7 ibr all the writers

» Op. cit, p. 44. "^.tp. ei.

DI8BASS or THE KIDNS7. 895

above cited speak of spirit drinking as the most fertile cause of this kind
of dropsical disorder, which, according to Dr. Bright, destroys not less
than ^ve hundred persons annually in London alone.

Then, as regards the employment of stimulant diuretics, they enter not
into the simple pharmacopcsia of the Water Cure. Dr. Osborne states,
that these medicines, as squilb, cream of tartar, and even the diuretic
ealts, are not guiltless in C9ntributing to the production of this disease of
the kidney ; and that by over-stimulating the kidneys, they become the
means of stopping the urinary secretion, and inducing the renal disease
and its consequences.* And Dr. Gregort, in his report of cases,* says,
** that the most remarkable diminutions in the urinary secretions took
place after the administration of squills and cream of tartar .•" evidently
pointing to their efl^t in exasperating the malady. Further, in quoting
these authors, it is necessary to remark, that they speak of the " stimvlanl
diuretics," and particularize some of them, as above. The laical reader
will understand the force of this when he learns that diuretics are classed
oy physicians into the *' aqueous" and the '' stimulant," the latter includ-
mg the saline, the acrid, the oleaginous, &c.' It is not probable that
accurate writers should have passed over the " aqueous" diuretics had
diey been detectable as a source of dropsy from the cause in question ;
the rather as, besides simple water, these include the infusions of simple
herbs and grains, copiously imbibed. So that, taking authority of a high
character, that terrible agent, water, does not produce dropsy so frequently
as those pleasant medicines, squill, colchicum, &c.

Lastly, a reviewer in the JEdinburgk Medical and Surgical Journal*
(supposed to be Professor ChrisTison), accuses mercury of causing
diseased kidney leading to dropsy, and alludes to Dr. Blaceall's dbser-
yations to the same efl^t. He says, ^ Two decided examples, if not
more, we have seen, in which no doubt could be entertained as to the
influence of this mineral in producing the morbid degeneration of the
kidney. Mercury seems in this case to apt very much like other exces-
sive stimulants, and by over-exciting the glandular part of the kidneys, to
lay the foundation of the morbid change." Sir Astlet Coofer also
classes mercury as a not infrequent cause of dropsy of the belly, speak-
ing of it in tha* agency as " by no means an extraordinary case."*

Still we have nothing of water in all this ; and mercury is assuredly
no part of the water cure. The &ct is, and educated medical men know
it, tiiat when a large quantity of water is introduced into the circulation,
it passes off by the skin in the shape of sweat, if external heat be ap-
plied : or by the kidneys, if the surface be kept cool, this being a process
of filtering only, and unaccompanied by the stimulation which marks the
operatiDn of saline and acrid diuretics, whose aim is to force the kidneys

* Op cit, p. 34. « Edinburgh Med. and Surg. Journal, u^fftiprflf
' Pereira*8 Elements of Materia Medica, vol. i., p. 20Q.

* Na czzviii., p. 198 * Lancet, April 3, 189f .

890 AFFUCDtX.

•t iSbe expense of other organs. It requires no depth of reflection to con*
dnde which is the more likely to bring on renal dropsy. We may add,
by way of rider, that Dr. Copland enumerates ^ the drastic operation of
purgatives" among the causes of dropsy :^ but does not place copious di*
Itttion in the list

6. '' The Wateb Cubs causes Rheumatism."

If so, the dogma on which Homcnopathy is based, and which asserts
that the same remedy which cures will cause a disease, is correct. For
in no complaint hidierto submitted to the water cure are its curative
efiects more decided, and even surprising, than in rheumatism; whether
acute or chronic. But the comfortable prejudice in favor of abundance
of flannel, a wilderness of fur, and the atmosphere of ovens, stamps the
promulgation of this dread of rheumatism with the only ingenuity thai
it can fairly claim : for daily and hourly experience leave it without a
vestige of foundation. To obtain rheumatism by the joint operation of
cold and moisture, two conditions are necessary ; first, that the individual
should be predisposed by a certain irritative condition of the digestive
organs, especially the liver, and of the nervous system ; secondly, that
evaporation of the moisture from the surface of the body should be unim-
peded, and the individual in a state of rest Place a man with sound di-
gestive organs between damp sheets, covered by dry blankets and coun-
terpane, and let the whole be arranged so as to forbid the passage of air
underneath the bed-clothes, and it is altogether impossible for him to
become rheumatic. In such case, the warmth of the body quickly trans-
forms the damp of the sheets into vapor, which being confined about tho
skin, engenders an atmosphere warm enough to satisfy the most comfort-
loving matron in the community. More than this : the consequence is
not rheumatism, even when there is the predispositiou in the digestive
organs; witness stage-coachmen and post-boys, who invariably suflbr
their under-coat to be well soaked with rain before they put on the upper
dry one kept in reserve : and who, although given to those ways whicli
irritate the digestives, neither get cold nor rheumatism by this proceed-
ing. The like applies to the well-known habit of the Highland shep-
herds, of wringing their under-garment out of cold water and covering all
with a dry coat, as the best means of keeping themselves warm^ when they
sleep on the mountain-side : yet they are not celebrated for their absti-
nence from whiskey, nor for attacks of rheumatism. All that is required
is, that evaporation of the damp clothing by the passage of air should be
avoided ; experience teaches this, and liie reason of it should be evident
to every medical man.

On the other hand, let a man's stomach and bowels be main^ned in
a state of irritation by purgatives, let him, more particularly, be in the

* Dictionary, p. 627. Art Dropay of the Jlbdom^,

RHEUMATISM ANS WATER. 99T

hMt of taking miniitG or large doees of mercury or iodine, it will be
found bow readily he takes rheumatism e^en by exposure to cold air,
not to mention the damjmess that is its usual concomitant in this island.
Yet pack the same man in damp sheets, and keep all but his face her-
metically excluded from the air, and though he were brimful of the re-
sults of mercury, he runs no more risk (not as much in the ultimate)
of becoming rheumatic by it than if he were in a bed heated by half a
dozen warming-pans. It is mere idleness to deny this without experi-
ence ; toe have seen the fact scores of times ; we have never seen rheu-
matism ensue on such treatment ; and we take leave to doubt whether
the persons with this rheumatic crotchet in their heads have ever tried
or seen tried the wet sheet, or any other portion of the water cure.
Would they desire to have other medical authority than ours for the
harmlessness of cold water and damp clothes ? Db. Hebebden, the
first physician of his day, says :

^ In England, few make any doubt of the great danger attending wet
rooms and damp clothes or beds. Is this opinion founded upon experi-
ence which has been suffered to grow up and get strength merely for want
cf being examined! If we inquire into the arguments in favor of this
notion, we shall hardly find any other than the random conjectures of the
sick about the cause of their illness, or than their artfully substituting
this origin of it instead of some other, which they are unwilling to own.
I hardly know a distemper, of which at difierent times I have not been
told, that it was occasioned* by lying in a damp bed or by sitting in a wet
room ; and yet Ida not know any one which will certainly be produced by
theu causes; and people frequently expose themselves to such causes
without suffering any ill efects. * * * It is a common practice in cer-
tain disorders to go to bed at night with the legs or arms wrapped in
linen cloth soaked in Malvern water ; so that the sheets will be in many
places as wet as they can be ; and I have krunim these patients and their
bedrfellows receive no harm from a continuance of this practice for many
months. Nor can it be said, that the Malvern water is more innocent
than other water might be, on account of any ingredients with which
it is impregnated ; for the Malvern water is purer than that of any other
springs in England, which I ever examined or heard of,*^

Is it the coldness of wet linen which is feared ? but shirts and sheets,
wolder than any unfrozen water can be, are safely worn and lain in by
many persons, who, during a hard frost, neither warm their beds nor
their shirts. Or does the danger lie in the dampness ? But then how
comes it to pass that a warm or cold bath and long fomentations can
be used without the destruction of those that use them ? Or is it from
both together ? Yet we have long heard of the thicldiess and continu-
ance of the cold fogs in the north-west of England ; but have never
yet been told of any certain ill effect which they have upon those who
Mv6 in them."'

^ Medical Transactions, vol. ii.

808' APPENDIX.

7. **TttB CRISIS nmrcTD by the water cure is dakgerotts."*

Awritw in the Quarterly Review for December, 1842, clubs this
** word of ter " with the last named, prophesying that ^ the water cure
will floorish until some person of note is crippled by a rheumatic fever
or dead from a carbuDcle.'' The employment of this term ^ carbuncle "
as indicative of the crisis, lays bare either the gross ignorance of the
writer on the subject of the water care, since he gives it as the <mly
oritical result, or the dishonesty of his purpose in thus attempting to
fix a formidable name on the agglomeration of two or three simple boils.
Let us inquire what *^ carbuncle " really is, and what the water boil
really is.

** Carbuncle," says Dr. Coflard,^ "has very generally been con-
founded with malignant pustule." This is so true that, putting aside
non-professional persons, who evidently attach the idea of mortification,
&,c,y to the term (on which account we presume the reviewer employs
it), we venture to say that seven out of ten medical men, if asked to de-
fine carbuncle, would call it *' a maHgnant tumor." The author just
cited ofiers a distinction between carbuncle and common bdil by repre-
senting the latter as '' having only a single opening, being smaller and
mure conical, and by several appearing in succession." Now, although
the critical boil of the water cure sometimes (by no means always, nor
even in the majority of instances) has more openings than one, and is
not 80 conical nor narrow based as a single Ordinary boil, yet it agrees
with the account of this last in appearing in more ^an one place. To
reconcile the discrepancy and to fix the true character of the water boil,
' we beg to refer, /rs^, to the opinions of Dupuytren'^ and Rayer,* who
describe carbuncle as " a tumor formed by the conglomeration and con-
fluence of se vend boils:" secondly ^ to the facts announced by Dr. Crai-
GiE,^ viz., carbuncle *' is accompanied by sickness, languor, restlessness,
and sleeplessness ; that the patient generally suffers much headache and
thirst, and his tongue is loaded with a thick, brown, dry fur : that he gene-
rally loathes food, and in some cases vomits more than once : that be
raves, faints," &c., &c. ; and lasUy, to the predisposing causes of car-
buncle, which are laid down by Dr. Copland,^ as consisting in " high,
rich, or gross living, with insufiicient exercise, a full, gross habit of
body, and neglect of personal cleanliness,"— K^auses which, he says, '* not
only predispose, but even more directly produce it."

It so happens that the water cure boil is never accompanied by the
constitutional symptoms above recited by Craigie; the patient loses

* Dictionary of Practical Medicine, p. 1056. Art Furvncular Diseases.
» Lectures iu the Lancette Frangaise for March, 1833.

s Theoretical and Practical Treatise on Diseases of the Skin, translated
by R. Willis, p. 549.

* Elements of Practice of Physic, vol. i., p. 640,
4 Loc. cit.

CBI8I8 OP THX WATBft CURB. tM

neither deep nor appetite : there is no disorder of the toi^;iie nor,by aaj
chance, any vomiting : and delirium and fiunting are circnnutancee alto*
fether unknown in its history. If any of the patients treated by us al
Malvern, who have had the crisis of boils, will assert that any one, or all
of these symptoms of carbuncle, usually so called, accompanied such
crisis in their persons, we are ready to give up the point, and allow that
the water cure boil is of the genuine carbuncle species, and of a danger*
ous character. In the meantime, as the like cause generally produces
the like ef^t, and as the bml induced by our treatment does pot produce
the same symptoms as the ** carbuncle" of authors, we are justified in
denouncing the dishonest motive displayed in attaching that much-feared
name to it

Further, it so happens that the water cure boil, so fiir from being con*
nected with '* high, rich, and gross living, with insufficient exercise, with
gross habit of body, or with neglect of personal cleanliness," as is the
case with the ** carbuncle of authors," appears, after strict but nutritious
dieting, abundant exercise, diminution of morbid fulness of habit, and,
most ^uredly, after no neglect of personal cleanliness, if water applied
in all manners can dean the human skin', or purify the human frame.
The identity of true carbuncle with the water boil thus fiiils in the com-
parison of causes, as well as of symptomatic effects : neither being trace-
able to the like causes, nor marked by the like results. Where, then, is
the honest motive in maintaining their identity 7

The only point in which they agree is the formation of more than one
opening, in which case they also agree in the more extended base and
less conical shape than an ordinary boil. But, as .we said, this is an
occasional occurrence only ; in very many instances, none but simple
and single boils are produced, to which it would be as fair to attach the
name and attributes of ^ carbuncle," as to the larger species alluded to.
What then is the genuine water boil about which such a hubbub is made ?
It is a conglomeration of several simple boils, and in so far, according to
Dufuytben's and Rater's definition, a carbuncle; but inasmuch as
these are generated in, and are indeed the signals of, a body cleansed of
its grossness and impurities after weeks or months of wholesome diet,
exercise, and watery applications, and not of a body in all the flush of
dietetic iniquities, these congregated boils have neither the carbuncular
discharge, nor are accompanied by the severe and dangerous constitu-
tional symptoms attendant on the genuine carbuncular inflammation.
Inasmuch, too, as the danger of an external diseased point is in exact
proportion with the c<mdition of the stomach, and other vital organs
within, and these are invariably put into order before the appearance of a
crisis of boils, the reason wherefore these latter induce no constitutional
derangement, and are therefore attended with no danger, whilst the
^* carbuncle" of authors is, will be clear to the reader. The water bdl
^ihg most extensive kind is only a ^ carbuncle" in the arrangement of the
■evtial boils winch form it ; in all other partieulan it iano man a car-

400 APnniMZ.

tende tfatn an ephemeral pimple od the hcnm is: nor is there any reaaoQ
why perBQDS — great or 8mall--«hould be '^ dead from it," as the sapient
^narteriy Reviewer somewhat gleefully anticipates.

Let it be understood, however, that we by no means class ourselves
with those practisers of the water core who appear to consider a crisis
if boils essential, and who, therefore, are much given to stimulate the
system without precise measurement of its capabilities. Let it further
be understood, that were we bent upon such coarse practice, there is
scarcely more than one case in twenty in which it is possible to induce
the cnsis in question. Of upwards of five hundred patients who have
been under treatment at Malvern, not more than twenty-two have had
an eruption of boils — ^large, small, or conglomerated. But we can
truthfully aver, that not one of these was deprived of an hour's sleep,
nor debarred of the usual exercise and diet for a single day ; and, as we
said before, there is no reason why they should be, if sufficient measure-
ment of the constitutional powers of the individual be made throughout
the progress of the case, and common sense with simple means take the
place of mystifying practice with complex means, when the boils make
their appearance.

But how does it happen that the public have only boils and '* carbun-
cles" held up in terrorem^ — ^that species of crisis which is tlie most rarely
obtained ? We jhink this question has been answered in the preceding
pages. Yet it were well that the reader should further learn that other
crises exist to which neither the formidable prestige nor name of ^ car-
buncle" can, even by perversion, be appended.

There is the simple ejlorescence of the skin which is apt to occur in
females.

There is also scattered and itching eruption of pimples scarcely above
the level of the skin, which is not an infrequent termination of nervous
cases.

There is the crisis of an attack of fexer of a few days' duration, a
very desirable ending of inveterate hypochondriasis.

There is the critical stoeating ; and the exudation of glutimms, acid
and sometimes foetid matter ; and there is a crisis of diarrhoea.

Any of these is much more frequently met with, in the treatment of
chronic disease, than the boils, the appearance of which depends quite
as much on the constitution of the individual, as on the appliances of the
water cure ; for, as we said, in some constitutions it is impossible, do
what one will, to produce this la^t-named species of crisis.

The principles and the facts of the crisis may be thus summed up.

Whenever an organ or series of organs in the state of morbid excite-
ment, which is present in acute and chronic disease, is placed, by art, in
a condition to cast off that excitement, the act is announced by a change
in some other organ, or series of organs.

This change is a crisis.

The nature and amount of this change, as weH as of the organs in

CBI8I8 OF THE WATB& CUBE. 401

wlilch it takes place, depend on the constitution of the individual, tha
nature and amount of the means employed, and the part to which thejr
are applied. *

But as this change never taltes place until the organ first diseased has
cast off its morbid excitement, the change alluded to, t. e, the crisis, does
not itself relieve the former, but is a signal that it has relieved itself; in
the same manner that tears do not bring relief to the mind, but are a sign
that relief has been brought. It is for this reason that a crisis of some
sort is desirable ; it is an evidence of good having been effected.

Still as, after all, the crisis is itself a morbid state, it is desirable to
produce it on some organ not immediately and strongly connected with
the central vital parts, — ^the stomach and bowels, brain, &c.

For the same reason, a crisis appearing, it is unnecessary and impru*
dent to urge the means with the view of increasing its amount It is a
sign of relief, and should be accepted as such simply.

Now the processes of the Water Cure place the primarily diseased
parts in a state to cast off their excitement : they further tend to make
the skin (an organ not immediately involving the great central organs),
the recipient of that morbid excitement ; and it remains for the practi-
tioner to regulate the amount of this new excitement of irritation, not
suffering boils, eruptions, sweat, &c., to tax the powers of the patient
beyond the requirements of the case.

When the malady consists simply in the retention of some evacuation,
and is not of such standing as to have vitiated the circulating blood, the
restoration of the evacuation is in itself a critical act, and no change in
any other organ is likely or desirable. The early stages of constipated
bowels, of retained montlily flow, or of suppressed perspiration, come
under this category.

When also the organic constitution of the individual is of a vivid cha-
racter, and the disease of the internal organ of comparatively short dura-
tion, this last is found not unfrequently to throw itself on some other
internal organ which does not so much involve the centre of life : then is
there an internal crisis. This has been instanced in the appearance of
loose bowels after irritated stomach and liver, which being more impor-
tant parts, have their disease carried off by the lower bowel, a part of in-
finitely less importance to the individual's life. The same applies to the
pouring off by the kidneys of acid and saline matters, as sometimes is
the case.

Thus the crisis e&cted by the Water Cure occurs either on the skin,
the lower bowel, or the kidneys, the parts which Nature, when she is
allowed to terminate disease by her own efforts, chooses for the same
purpose. In doing this, the practitioner of the Water Cure only follows
Nature ; but to hear the hue and cry about the crisis, one mig^t imagine
such an act had never been perpetrated by Nature, or assisted by art,
before the time when Priessnitz developed his mode of treatment. Yet
it would perhaps be difllcult to find % sulgeot in the whole xaage of i

40t APPENDIX.

eiae ^ich has imgaged the attentian of so many eminent medical writ
en, from Hotocrates,* to Collen,' Richteb,' Fbahk,^ Hildehbraiid,
Sretssio/ who an insist on the importance of acting upon the broad
hint given by Nature for her own relief. And the crises enumerated by all
authors are precisely those we have alluded to, not excepting the terrible
boils which our medical brethren would &in make the world believe had
never been heard o£

II.

PROPOinnONS ON THE PRINCIPLES AND PRACTICE OF
THE WATER CURE.

I. A series of unnatural symptoms constitutes a disease,
n. This disease is referable to a morbid condition of some of the tex-
tures of the body.

III. All disease is originally acute, that is to say, the symptoms are
more or less rapid and pressing in their character, and more or less cha-
racterized by fever.

IV. Acute disease is the e£fort of the morbid organ or organs to throw
off their disorder upon some less important organ or organs. Thus aciite
inflammation of the liver, stomach, or lungs, causes fever, that is, an
efibrt to throw the mischief on the skin, the bowels, or the kidneys.

V. If, from the great extent of the mischief to be thrown oflT, and the
feeble constitution, acquired or natural, of the individual, this efibrt is not
successful, the body dies from exhaustion.

VI. If this effi)rt be only partially successful, more or less of the inter-
nal mischief remains, but gives rise to symptoms of a less rapid and press-
ing and more permanent character. These symptoms then constitute a
chronic disease.

Vn. Except in the case of accidents to the limbs, we know of no
disease which is not essentially internal. Skin diseases are invariably
connected with disease of some internal organs, especially the stomach
and bowels, and are regulated in their character and intensity thereby.
This is so true, that where there is a skin disease, the crisis e&cted
by the water cure invariably takes place i»n the spot where it ezusts. .

Vni. AciUe diseasCi then, is the violent efibrt of internal and vital
cngans to cast tl^ir mischief on external and lees important organs.

' Opera, ed. Vander Linden, t. i. et passim,
■ Worka by Thomson, v. i., p. 5P3.

* Die Specielle Therapie, p. i., p. 57.

* De Curandis Hominum Morbis, r. 1., p. 56.

* Institutiones practlco-medics, y. i., p. 66.

* Xncyelopid, Wdrterbuch der Medicin, Wiisenschaften, p. 8, p.

noTosmous of thb watse citkb. 40S

IX. Chronic disease is the enfeebled effort of the same orgaiiB to
the same end.

X. But as from the diminished power of the constitution this Ts
always inefl^tual, the morbid state of the organs tends constantly to-
wards disorganization, or what is called organic disease. This is more
certainly the case, if the original causes of the malady are at work.

XI. Disease therefore is curable when the power of the system is
enfficiently strong to throw the morbid action from a more to a less
important organ.

XII. DiseaQse is incurdble when the power in question is insufficient
for the last-named purpose ; and when it has become organic, that is,
when a change of structure has taken place.

Xm. From these premises it follows that the aim of scientific treat
ment should be to aid the development of the power of the system and
its effi)rts to rid its vital parts of mischief.

XrV. That mischief invariably consists in the retention of an un-
natural quantity of blood in them, to the detriment of other parts of
the organism, — a retention commonly known by the terms acute tn-
ilammation, chronic iitflammation, and congestion,

XV. In endeavoring to develope the powers of the system, the dissi-
pation of this inflammation or congestion must be constantly kept in
view, as the end of which the constitutional efS>rts are the means.

XVI. But as the circulation of the blood everywhere is under the
influence of the organic system of nerves, the power and efibrts of these
last are essentially to be strengthened in order to dissipate the inflam-
mation or congestion referred to.

XVn. Curative treatment is therefore made through the instrumen-
tality of the nervous system.

XVlli. Violent and sudden stimulation of the nervous system of the
internal organs, is invariably followed by exhaustion and increased in-
flammation and congestion. Hence the impropriety of alcoholic and
medicinal stimulants.

XIX. But the gradual and judiciously regulated stimulation of the
nervous system according to the organic powers, conduces to the de-
velopment and mainienance of its strength.

XX. This stimulation is the more steady and certain in its results
the more universally it is applied to the entire nervous system.

XXI. To the external skin, therefore, and to the internal skin (as
represented by all the lining membranes of the lungs and digestive
organs), this stimulation should be applied, those parts containing the
largest portion of the nervous system spread through them.

XXn. Pure air applied to the lungs, proper diet, and water applied
to the digestive organs, and water applied to the external skin, fulfil
this intention of stimulation and strengthening most eflfectually.

XXni. Farther, as that portion of the nervous system (the brain
and spinal cofd)> in whkk the will resides, reqaiiw the devdopoMiit

404 AFPUTDIX.

of ita powen, exercue of the limbs is requisite, the stimnktioD of the
air, diet, and water aiding thereto.

XXIV. PUBE WATEB, PURE AIK, PROPER DIBi; AMD REOT7LATED EZER-
CI8B, ARE THE GREAT AGENTS Dl EFFECTDIG THE CURE OF DISEASE BT
AXDIKG THE HATURAL EFFORTS OF THE BODY, THROUGH THE ntSTBU-
MERTALITT OF THE HEBYOUS SYSTEM.

XXV. Ir THE DUE APPOBTIORHERT OF THESE AGEKTS, AGCOBDIKG TO
THE POWEBS OF THE COKSTITUTIOB AHD THE PHASES OF DISEASE, AS
ASCEBTADfED BT MINUTE MEDICAL EXAMINATIDN, CONSISTS THE SGIEN«
TIFIC AND THE SAFE PBACTICE OF THE WaTEB CuBE.

XXVI. As Btrengthening of the system by the regulated stimalating
of the nervous system is the means, so the throwing ojQT disease by more
important on less important organs by that acquired strength, is the end
of that practice.

XXVII. During the efforts of the system thus aroused for so beneficial
an end, if agents are employed which divert those efforts and tend to
centre stimulus on the more important organs, augmented mischief is the
certain result. Such agents are to be found in alcoholic and medicinal
stimulants, applied to the internal skin and nerves : in hot and impure
air applied to the external skin and nerves ; and in exciting and fEu^titious
pleasures and anxious cares applied to the great centre of the nerves, the
brain.

XXVm. These and the mailrapporiwnment of the stimulation included
in water, air, diet, and exercise, give rise to the only " Dangers of the
Water Cure."

XXIX. The proper apportionment ol the stimulation in question origi
nates and maintains a steady effort of the system to save its vital parts
at the expense of parts which implicate life less immediately.

XXX. The result of this effort is shown in one of the following ways :
1, the re-establishment of obstructed and suppressed secretions ; 2, in the
elimination of diseased matters through the bowels, kidneys, or skin ; 3,
in the formation of a critical action of some sort on the sMn.'

XXXI. Such result constitutes the Crisis of the Wateb Cube.
XXXn. The Crisis being the result of the extrinsic efforts of the vita]

organs, is to be viewed as the signal of their relief, not as the instrument
of their relief.

XXXm. Still as, during the crisis, the tendency from the internal to
the external organs is most strong, it is more than ever necessary to
avoid the causes which act in diverting this tendency and in reconceiv
trating the mischief on the internal parts.

XXXrV. At the s&me time, the tendency in point being then strongly
established, it is not necessary to stimulate the system further in that

1 For the various kinds of critical action, see what has been above stated
on the subject of the crisis of the Water Cure.

FROPOSITIONS OF THE WATER CURB. 405

direction, and all treatment except that which allays irritation accordingly

XXXV. A crisis being the evidence of cure of the internal disease,
no recurrence of the latter is to be apprehended^ unless the morbid causes
are re^pplief.

XXXVI. It is, however, possible, and in a great number of cases hap-
pens, that complete recovery from disease is efiected by a slow process
without any perceptible evi^nce of a crisis, either external or internal

•* Booo wan n ILut lo jjfe ^on Ofhci nr m Vvtrnt SEina."

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PROSPECTUS

&( €Yt 3i^ lUastrattir

HYDROPATHIC QUARTERLY REVIEW,

A PROFESSIONAL MAGAZINE,

Dktotbd to Medical Reform, exbbacixg Artpcles by The Best Writebs on
ANATO)iT, Physiology. Pathology, Surgery, THERAPEUTica, Midwipbrt,
etc. ; Reports of Remarkable Cases in General Practice, Criticisms on

THE theory and PRACTICE OF THE VARIOUS OPPOSING SYSTEMS OF MeDICAL

Science, Reviews OF New Pcblications of all Schoom of Medicine, Re-
ports OF THE Progress of Health .Reform in all its aspects, etc., xtg.,
with Appro pkiate Engraved Iliajstrations.

At the BolicUation of many of the leading practitioners and prominent friends

of Water -Oire, the sabscriber* have cominenced the publiciuion of a Nxw IixusniAnD Quab-
miLT Maqazinc, with the above Title. It is more strictly ScienUfic and Professional than the
WiUer-Cure Journal, and more especially the medAtm through which the Professors and Physi-
cians of the Hydropathic school can commuoicat« to each other and the pablic their views in
relation to all departments of the Healing Art, and the results of their investigations on all sub- .
)tciB pertaining to Health-Reform and Medical Improvement. lu matter will be arranged under
the following general heads :

L Essays.
The most learned and experienced writers in America and Europe will fumiah

articles on Anatomy. Physiology, Pathology, Surgery, Therspeulics, Midwifery, the Laws of
Health, Philosophy of Water-Cure, etc., which will be Amply Ilu7STIU1XD«bt izdb Most AoctTBADI

AXD B£ACTIFULLY EXWCUTKD EnG&AVIKGS WS (UN PROCtmB.

n. Reports.
Remarkable cases in Surgery, Obstetrics, and in General Practice, treated <m

Hydropathic principles, will be reported in detail, by the most eminent and scientific practitioners
and teache/s of our system. An interesting and instructive feature, also, will be the Reports of
the mo»t important cases presented at the Cliniqtie of the new school of the Hydropathic and
Hygienic Institute, now in operation at 15 Laight street. New York city.

III. Criticisms.

In this department, the cases treated by physicians of those systems we oppoee

will be noticed fairly, and commented on with unlimited freedom. Their errors in theory will
be exposed ^ their fallacies in practice exp'ained ; and the better way indicated by a contrast
of results with those of Hydropatliic pruclice.

IV. Reviews.

New Publications, whether Ijooks or periodicals, of all actual schools or pre-
tended systems of medicine — Allopathic, Homeopathic, Eclectic, Mesmeric, Botanic, etc., will be
closely but candidly examined, and severely but impartially criticised. The good or bad — ^e
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V. Records,

Here will be noted the triumphs of our system, and the pro^presB of Health-
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Each number will contain from 190 to 200 or more pages ; and each Volume will make Ml
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THB NEW ILLUSTRATSD

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of the People have been steadily kepi in view. Whilst almost every topic of interest la the
departments of Asatomy, PBrnoLOOT, Patboloot, Hyoisnk, and THiourEUTic^, is briefly pr&>
seated, those of practical utility are always put prominently forward. The prevailing errors,
conceits, and whims of the day and age are exposed and refuted ; the theories and hypotheses
upon which the popular drug-practice is predicated are controverted, and the why and where-
fore of their fallacy clearly demonstrated.— Illustrated with TtaBSB Hukdbxd Enqravikgs.

The following is a brief analysis of its contents :

Histoby of Medicine ; History of Bathing ; History of Medicated Baths.

Akatoky, illustrated by One Hundred and twenty appropriate Engravings.

Physiology, Illustrated, comprising the subjects of the different Struc-
tures, and their vital Properties ; Rationale of Muscular Action ; the Nervous Influence ;
Philosophy of Mind ; Mesmeric Phenomena ; the Special Senses ; the Functions of Digestion,
Circulation, Respiration, Absolution, Nutrition, Secretion, Excretion, Calorification, Tempera-
ments, Races, and Theory of Population. Eqich Subject amply Illustrated.

Hygiene, embracing all the relations of Air, Light, Drink, Food, Tempe-
rature, Exercise, Sleep, Clothing, Bathing, the Excretions and the Passions, to the Growth and
DeveloiHuent of Body and Mind, the Preservation of Health, and the Attainment of Longevity.

Dietetics, comprising the Bible, Anatomical, Physiological, Chemical, and

Experimental Evidences concerning the Natural Dietetic Character of Man.

Hydrofathic Cookery, with Special Directions for the Preparation of Food.

Dietaries, containing the Therapeutic Distinctions of Diet for invalids.

Philosophy of Water-Cure, with illustrated explanations of all the Water-
Care appliances, a Philosophical exposition of the Modus Operandi of Water-Treatment, and
the true Rationale of Drug-Treatment.

The Nature, Symptoms, and Treatment of all known Diseases, in which the

theories of the Allopathic schools are examined, their absurdity and the ill-success of drug-
practice exposed, and the proper Hydro-therapeutic Medication recommended and specified.

The Treatment of Surgical Diseases, illustratbd, and directions for the
minor operations, given, with suitable examples.

The Management of Lying-in-Women, and the Treatment of Children, &c.

The work Is intended to be a plain, intelligible, and suflBcient guide for Do-
mestic Practice, or Home Treatment, m all ordinary diseases, Embracing the whole range of
subjects connected with the Philosophy of Life, the PreservaUon of Heklth, and the Treatment
of Diseases.

A new edition of this great work has recently been printed, and may be had
in Two handy 12mp Volumes, or in Oxb Largb Ootjlyo VoLtTUE, Bound in Library style. Price
for Either E(j|iticm delivered, or pre-paid by mail to any Post Office, only Thrkb Dollars.

AI^Letters and Orders should be| FOWLERS AND WELLS,

directed as follows : / Cumon Haix, 131 Nitftuu St., New York,

Aenns in &very Neighborhood will be iSappHed in packages of a Dozen or moro Gopii
EzfTMi, or m Fnight. Siagl* CoplM, hy Mail. Bwry Famfly Should haT* a Copy.

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